Hello,

I'm 4 months post Epi-Lasik. I had -1.25 astigmatism in both
eyes and .5 myopia in my right and -1.00 in left. I see 20/15
however I notice in my right eye there is ghosting effect in dim
light situations such as in dark scenes at the movies, watching
tv, at a bar when i see light reflecting off someone at a distance.
And in a completely dark room, in both eyes, the computer or
when I'm driving there is a starburt effect that around car rear
lights that go away as i get closer to them or are not there when
i'm driving on a street or highway with light posts. Now the
effect is coming mostly from the sides of the light object rather
the top/bottom. I also am exeriencing Night Glare from cars and
even glare during the day from the sunlight reflecting of my bed
sheets. My dim light pupil size was measured at 7.0 in 1 eye and
7.5 in the other. I saw that my doctor did a 6.7mm x 6mm
optical zone to a 8mm ablation zone. Does this seem like an
accurate treatment for my prescription/pupil size? From what
I've been reading the optical zone should have been 7.5mm to a
8.5 ablation to prevent the above disturbances. Not sure of the
corneal thickness so I don't know if that was a factor. Are these
effects pupil size related? My astigmatism was also twice the
myopia in my right eye so could this also have affected my
outcome? Will I have to wait for my pupils to naturally shrink in
size as I age? I'm 30 and also now have strand type floaters that
weren't there before surgery. I believe they were caused by the
suction ring and in retrospect would have gone with PRK as the
short term discomfort would have been much better than the
long term affect of floaters. I wish my doctor would have made
me aware of that complication. I also have Dry Eyes, and have to
put an ointment to prevent the possibility of waking up with a
corneal abrasion. Am I overreacting, still healing and should see
an improvement at 6 months and at 1 year? I also went to what I
thought was the best, Bascom Palmer in Miami. Don't get me
wrong, I'm greatful for the 20/15 but it was at the expense of
Quality.

Thank you for your question. the good news is that you were treated with the correct ablation zone. I have performed a study looking at pupil size and preop level of myopia with a device called the Larson Glarometer. In fact - since I work in Miami - you are more than welcome to come in for a consultation and we can look at your night vision issues more carefully.
Basically - my research has shown that for low degrees of myopia, the standard Customvue treatment does a beautiful job of correcting the refractive error as well as avoids creating night vision symptoms after surface ablation.
What my study also found out is that the sourece of symptoms like you are describing is a small residual refractive error. In my study, when patients were placed in trial frames with their residual refractive error, the size of the night vision aberration shrunk (if it was enlarged after surgery). Again - this is talking about patients with low degrees of myopia (less than -3.5) with large pupils (7.0 to 8.5mm) as measured with a Colvard pupillometer.
So...if you were to come to my office, we would check the size of your night vision aberration with a device called the Larson glarometer with and without correction to provide an idea of what is causing the aberration.
Another possible cause is irregular astigmatism, which can occasionally occur. This will cause some visual symptoms, which will be worse at night. Treatment would consist of a contact lens (to show that it is resolvable) and of course treatment with custom ablation.
Finally - it is important to treat any residual dry eye that you may have. You can ask your doctor about: Punctal plugs, Restasis, etc if you have some dry eye.

I hope this helps

Bill Trattler, MD
Miami, FL

I had Intralase/Lasik about 6 months ago and I have all the
usual side effects. I was told by another Dr. that my pupils
were too large for lasik and he recommended PRK. I went
to another Dr. for a second opinion, and because he was
voted "best in Baltimore/Washington". One thing you
mentioned was "floaters" I too have what appers to be a
thread almost like a jellyfish suspended right in my line of
sight in my right eye. i swear it wasn't there before surgery,
but my Dr. tells me there is nothing about the procedure
that would have caused it. The Dr's response is that the
"floater" was always there, and I just couldn't "see" it
before.