What do the LASIK surgeons here feel about making a LASIK eye myopic again?

I have had just one eye operated on with LASIK in Jan. of '99, and the night vision problems are intolerable. This is due to the mis-measurement of my pupil in dim light, which was purported to be 6mm but is in reality 8mm+. The other serious problem is anisometropia (OS: +.25, OD: -3.5), preventing me from wearing glasses. With these problems, I am afraid to have the other eye operated on now and I think that I would really prefer being myopic in my LASIK eye again, night vision problems and all.

MY QUESTION: One surgeon has proposed to me that he could make me myopic again by doing a hyperopic treatment in OS, and that the night vision problems may even be less as a result. He admits that it is difficult to predict where I would wind up refractively, but that the chances are very good that I would be within the two diopter difference necessary to make glasses tolerable.

Has this been tried before? Are there any unique risks to this approach? What other options do I have?

Thank you,
--Red

Message:
I do not think that performing a hyperopic treatment after myopic LASIK will have any improvement on night time symptoms, and in fact may exacerbate the situation.
My first question is - have you determined that the night time problems are due to your pupil problems alone. Does a single drop of pilocarpine completely eliminate the night time problems in the eye that had LASIK? Is there any irregular astigmatism or flap striae that can explain why you have these night time symptoms.
My second question would be about soft contact lenses. Have you been able to tolerate soft contact lenses in your untreated eye, which would eliminate the anisometropia.

I hope these comments are helpful

Bill Trattler, MD
Miami, FL

Yes, I have done the "flashlight test" (as described by Dr. Horn), by shining a pen flashlight in my eye in a dark room, and this significantly decrease GASH problems. So, I am confident that pupil size is the culprit.

I have a difficulty wearing contact lenses for a long time, hence the original motivation for LASIK! As you can see, I am "trapped", in that my only option right now is to wear a contact lens in the unoperated eye.

Have you tried low dose pilocarpine, which lasts only a few hours. This is a better way to test whether your night time symptoms are due to pupil size. As well, it is potentially a temporary treatment which you can discuss with your doctor. Since you are obvisouly having difficulties at night, pilocarpine may help you improve things while you wait/determine what to do next

Bill Trattler, MD
Miami, FL