I am about to have Lasik wavefront surgery with the VISX S4 wavescan laser and was hoping someone could tell me if this laser is suitable for my eyes. My prescription is -1.25 and -1.50 with no astigmatism apparently my corneas are quite thick and my pupil size is 7mm. After reading all the problems with larger pupils could someone let me know if this laser is up to the job.

Candice,

4 weeks ago I had custom LASIK, very similar eye measurements as yours...same pupil size, I also have thick corneas, and the VISX S5 laser was used.

The results are awesome! I am 20/20 in both eyes and I am adjusting nicely. My biggest concern was halos and bursts affecting my night vision. I can say that I see no halos and bursting is minimal at best.

LASIK was the right decision for me. I love it, I love the freedom that it feels I have. After 20 years of glasses I am free

Hope you have a similar experience.

Candice,

No one will be able to give you any absolutes regarding your pupil size and treatment with a Visx S4 excimer laser. What you can gain is insight and some strong indications of what is reasonable to expect.

We have a detailed article regarding pupil size and Lasik at http://www.USAEyes.org and click on | Considerations | Pre-Existing Concerns | Large Pupils |

Rather than repeat the article, I'll just add some thoughts that relate to your situation.

The maximum size of the optical ablation zone (full correction) with the Visx S4 is 6.5mm. This drops down in size to treat astigmatism. If your pupil size is measured in low light, the full optical treatment zone will not be equal to or larger than the size of your naturally dilate pupil and you will not gain the maximum margin for safety. That may or may not be an actual issue.

As explained in the article cited above, pupil size alone does not reliably predict night vision problems. You have a very low refractive error and people with low error tend to not develop night vision problems even when the optical ablation zone is smaller than the pupil size. This is, however, an elevated risk. It may not be much of an elevation, but it is not the absolute most safe technique.

I speculate that every refractive surgeon you meet would agree that you do not have an elevated risk of night vision problems because of the combination of low refractive error and pupil size close to the size of the optical ablation zone. We are a more conservative bunch so we are going to point out that it is elevated, but acknowledge it is not elevated dramatically.

Ultimately you must decide what amount of risk you are willing to accept. However you may not want to have surgery at all for a totally unrelated reason.

If you are at or near age 40, you may want to keep your low myopia (nearsighted, shortsighted) vision. Visit our website and click on | Considerations | Pre-Existing Concerns | Presbyopia |

Also, if you do decide to have surgery a VERY strongly recommend that you consider a surface ablation technique like PRK, LASEK, or Epi-Lasik instead of Lasik or IntraLasik. At our website click on | Considerations | Which Surgery For You? | LASEK | for details and be sure to discuss the advantages and disadvantages of surface ablation with your doctor.

Glenn Hagele
http://USAEyes.org
Patient Advocacy & Surgeon Certification

I am not a doctor.