I am a 52 yr-old male who had bilateral LASIK on 8/1/06 (IntraLASIK with VISX S4 Star wavefront-guided ablation) and have experienced profound halos, starbursts, and dry eye pain ever since with no improvement. Halos and starbursts are much worse at night, but I also see starbursts when the sun reflects off of shiny surfaces in the day.

My undilated pupil size is 3.63mm (approximate – both eyes). Pupils measure 4mm with a Colvard pupillometer. Pupils needed to be dilated to obtain an “accurate” wavefront scan measurement. Records show that they were dilated to 5.25mm and 5mm. Optical zone was 6 x 6.5mm with transition out to 8mm.

My surgeon claims that my aberrations are definitely not pupil-related, but he can’t explain why I have them. He claims that the laser tracking was enabled and accurate. I have since read that it is difficult to obtain accurate wavefront scans with small pupils like mine and that dilating the pupils can potentially affect accuracy of the measurement. Furthermore, VISX claims that the safety of LASIK on pupils smaller than 6mm has not been evaluated, implying that it is not advised. My post-op topography map shows the flattest area of my cornea (blue) skewed superiorly and I’m wondering if I’ve had a decentered ablation, which is contributing to the halos and starbursts.

In addition, I’ve learned by obtaining copies of my records after surgery that my Schirmer test resulted in a reading of 4mm, which is very low. My surgeon’s response, when confronted with this information, was that males rarely suffer dry eye beyond the healing period (6 months) so, apparently, he was not concerned.

Should not my Schirmer test result and small pupil size have been considered contraindicators to surgery by the physician, which he should have discussed with me? Any ideas on what could be causing my aberrations? Thanks