Given certain empirical information, can I mostly rule out large pupil size as being the primary issue in my visual aberrations? Five months postop from lasik, I'm becoming increasingly concerned by all the daytime and nighttime visual aberrations I'm still experiencing with no improvement I can tell since the six week point after surgery. My very experienced surgeon says he's never had a patient with this degree of symptoms at this point in time, not improved with glasses or alphagan, and is "at a complete loss". I have low contrast and see glare, halos and starbursts both day and night (though much worse at night), out of both my Custom Lasik and Conventional Lasik eyes, with or without glasses, even after Alphagan drops (though I could use these only once because of adverse reaction), even with a dim flashlight lighting across my eyes from the side. My eyesight is probably at its best in movie theatres, if that's some kind of clue. I can describe the symptoms in more detail if needed. Does the fact that I have the effects quite a bit even during the day mean my problems are unlikely to be from pupil size? My ablation area was 9 mm (Ladarvision 4000) and my pupil size was supposedly 6 mm, but I have some reason to believe that they might not have been accurately measured (if at all). Certainly my surgeon never discussed pupil size with me. Also, after the lasik I was traveling and consulted an independent optometrist because of my problems and because I had come to learn about the issue of lasik and pupil size. He measured my pupils as approximately 7.5 mm in dim light though emphasized that this was just a rough measurement taken with a ruler. Are there any other tests I can perform myself simply to get an idea if this is likely to be my problem? Thanks for any opinions you might have.

Flap striae are an important potential cause of your symptoms. They can sometimes be difficult to visualize - but they are best visualized by your doctor with:

1. Fluoroscein dye
2. Dilation of the pupil and evaluation of the flap in retro-illumination

Another cause is significant dry eyes. You should talk with your doctor and see whether dry eyes are an issue. Restasis, punctal plugs, warm compresses, etc can be helpful

Finally - you should ask your doctor for a recommendation for a second opinion
There are lots of great doctors in San Fran. Ella Faktorovich is great. Neil Friedman is great. Ed Manche is great. There are many solid options

Best regards

Bill Trattler, MD
Miami, FL

Thanks so much for your response. I will follow through soon with getting a second opinion as you suggested. I do have significant dry eye syndrome, especially post-lasik, and one of my eyes even got stuck together 20 minutes after the surgery. I've used punctal plugs, restasis, eyedrops, gel, hot compresses and many other remedies and lately my eyes are much wetter. It's true that some of my visual aberrations, especially the kind that I place in the category of "diffuse halo", are less severe (i.e., smaller diameter) when my eyes are wetter; however, the aberrations are always present whether my eyes are wet or dry. A main feature of my visual aberrations that I don't often see others describe is that almost always I see very fine lines (or what I call "scratch marks") in patterns inside of the halos or starbursts. These don't seem to be affected by whether my eyes are wetter or drier. These "scratch marks" are very striking and can look like fine lattice lines, or fish scale patterns, or large "Z"'s etched under streetlamps, or most often simply finely cut lines radiating out from the center of light sources. Essentially, they remind me very much of the light diffraction patterns I got when looking through my car windshield after somebody I knew had scrubbed it vigorously with a choreboy in a circular pattern to get off a mineral deposit. I even sometimes get the same effect that I had with that windshield in that when looking at a bright white light source (day or night), there can be a starburst of rays, and within each and every ray there's an irridiscent rainbow. I sure hope if the cause is flap striae it's not too late to do something, since I'm already five months postop. Again, thank you for responding to my post.

There are many options now for late diagnosis of striae - including flap suturing and PTK (laser removal)

keep us posted

Bill Trattler MD
Miami, FL