Hello,
I recently had a LASIK evaluation. The doctor
said I was perfect candidate except for my
low-light pupil size (7mm). He told me I would
have "halos" at night for the rest of my life.
Then he wanted me to really think about it before
I decide to do the procedure. As I think about
it, I have many questions that I hope you all can
help me with. Any information (whether one of my
questions or not) will be beneficial to me in
making my decision. Some more background, I am
myopic, my contact prescription is (R) -5.0 14.0
8.6, (L) -4.5 14.0 8.6. The doctor has a Nidek
with 6.5mm coverage and 1.5 transition and a Visx
with a smaller coverage (I don't remember). Now
some of my questions:
Could the evaluating doctor have made a mistake?
Could this pupil size change during my life
(become smaller or bigger)? Do you deny or
discourage people with my "condition"? What is
the general consensus of patients with my
"condition" who went ahead with the procedure?
How dissatisfied is the worst case patient? Is
there (or will there be) other excimer lasers that
have 7mm+ coverage? Is there a test, chart or
pictures that will help show me what the possible
or probable outcome will be? (Would the doctor
have them? Would they be on the web?)
Also, the doctor mentioned I probably have the
halos now from my contacts and just not realize it
(he said my contacts probably don't have any
better coverage). I went out at night and checked
for it. I didn't see any "ring" of light around
car lights, street lights, etc. but I do see a
little "fuzz" around street lights, stop lights,
and I do notice tiny star bursts from car
headlights at a distance. They are all very, very
minor (thus didn't notice them before) and they
appear the same when wearing my glasses. I don't
know if this is what he is talking about or not
(it could also be the So Cal smog).
Please bear with me, this side effect seems a bit
scary to me and I don't want to be disappointed
for the rest of my life because I made this
decision in haste. I thank you in advance for
sharing your knowledge.
Jeff

First, most times the problem is that the pupil size is mismeasured as being smaller than it really is. I would assume that you have large pupils, although seeing other doctors may be helpful in determining this.
I would agree that there are risks of night time problems with both the Nidek and VISX laser machines, and I am happy to hear that your surgeon explained this to you. Unfortunately, many patients with these problems are miserable, so you should consider an alternative. The Autonomous laser can treat out wider, so you might consider seeing a LASIK specialist who uses this laser. I would mention that corneal thickness is important, as more laser treatment is required when a larger optical zone is selected for the laser treatment.

I hope this helps

Bill Trattler,MD
Miami, FL

>Hello,I recently had a LASIK evaluation.
>The doctorsaid I was perfect candidate
>except for mylow-light pupil size (7mm).
> He told me I wouldhave
>"halos" at night for the rest
>of my life.Then he wanted me
>to really think about it beforeI
>decide to do the procedure.
>As I think aboutit, I have
>many questions that I hope you
>all canhelp me with. Any
>information (whether one of myquestions or
>not) will be beneficial to me
>inmaking my decision. Some more
>background, I ammyopic, my contact prescription
>is (R) -5.0 14.08.6, (L) -4.5
>14.0 8.6. The doctor has
>a Nidekwith 6.5mm coverage and 1.5
>transition and a Visxwith a smaller
>coverage (I don't remember). Nowsome
>of my questions:Could the evaluating doctor
>have made a mistake?Could this pupil
>size change during my life(become smaller
>or bigger)? Do you deny
>ordiscourage people with my "condition"?
>What isthe general consensus of patients
>with my"condition" who went ahead with
>the procedure?How dissatisfied is the worst
>case patient? Isthere (or will
>there be) other excimer lasers thathave
>7mm+ coverage? Is there a
>test, chart orpictures that will help
>show me what the possibleor probable
>outcome will be? (Would the
>doctorhave them? Would they be
>on the web?)Also, the doctor mentioned
>I probably have thehalos now from
>my contacts and just not realize
>it(he said my contacts probably don't
>have anybetter coverage). I went
>out at night and checkedfor it.
> I didn't see any "ring"
>of light aroundcar lights, street lights,
>etc. but I do see alittle
>"fuzz" around street lights, stop lights,and
>I do notice tiny star bursts
>from carheadlights at a distance.
>They are all very, veryminor (thus
>didn't notice them before) and theyappear
>the same when wearing my glasses.
> I don'tknow if this is
>what he is talking about or
>not(it could also be the So
>Cal smog).Please bear with me, this
>side effect seems a bitscary to
>me and I don't want to
>be disappointedfor the rest of my
>life because I made thisdecision in
>haste. I thank you in
>advance forsharing your knowledge.Jeff
Your situation is not uncommon and we have treated many patientl like you with good results using the Autonomous laser which can do as large as an 8.0 mm treatment zone with a 1.0mm blend zone but to do that your cornea has to be thick enough and that is measure pre-operatively and at the time of surgery. We would also like to pre-test you with Alphagan drops which prevent the pupil from fully dilating in the dark. If your pupil is only 5 to6mm after the Alphagan that at least allows you to have an option if you do develop glare despited the largest possible treatment zone. I assume your pupils were measured with an infrared device in a dark, inside room. I have found over 10 years of doing laser surgery that no matter how sophisticated we are about all these tests, new lasers, drops etc. it is still difficult to predict who will have trouble. For that reason we always do the non-dominant eye first and let you compare the night vision between the LASIK eye and the contact lense eye. Sometimes the glare, if you have it, can improve with time so we wait to see how you do. In the meantime, if the glare is really troublesome, you can usually manage with the Alhpagan drops. Then you can make a truly informed decision about whether to have surgery on your non-dominant eye. If you would like, we can have you talk to one or two or our recent large pupil patients to get their advice. I encourage you to take your time and explore all your options and I commend the doctor who pointed out the potential problems to you rather than simply telling you you were a perfect candidate as we saw on Primetime Television a few weeks ago.You can call Donna at our office in LA if you want to talk to patients with large pupils who were treated with the Autonomous Laser. call 323 653-3800

Hello All,
I want to Thank the two doctors who responded to my posting. After reading them, I decided to have another consultation with a second doctor. I chose a doctor that a few of my coworkers have been to and my optometrist recommended (also because he has an Autonomous laser). Their method of measuring my low-light pupil size was different. This method used an infra-red measuring device, which I would assume to be more accurate. The size came out to be 6.5mm. I thought "GREAT!", but it aroused another question: The light was turned off for only a minute or so before the first eye was measured. Was this an adequate time for my pupils to expand to their largest natural size? Should I ask them to redo this test before I accept the results? Also, this doctor has multiple lasers, is it in my best interest to ask him to use the Autonomous laser (given my pupil size at 6.5mm)? Thank you again for your information.
Jeff

>Hello All,I want to Thank the two
>doctors who responded to my posting.
> After reading them, I decided
>to have another consultation with a
>second doctor. I chose a
>doctor that a few of my
>coworkers have been to and my
>optometrist recommended (also because he has
>an Autonomous laser). Their method
>of measuring my low-light pupil size
>was different. This method used
>an infra-red measuring device, which I
>would assume to be more accurate.
> The size came out to
>be 6.5mm. I thought "GREAT!",
>but it aroused another question:
>The light was turned off for
>only a minute or so before
>the first eye was measured.
>Was this an adequate time for
>my pupils to expand to their
>largest natural size? Should I
>ask them to redo this test
>before I accept the results?
>Also, this doctor has multiple lasers,
>is it in my best interest
>to ask him to use the
>Autonomous laser (given my pupil size
>at 6.5mm)? Thank you again
>for your information.Jeff
Your pupils dilate quickly so the test was probably accurate. I would do a 7.0 zone with the Autonomous if your cornea is thick enough and do me a favor and request one eye at a time, non dominant first, so you can actually compare the quality of your night vision with your contact lens eye before deciding on surgery for that eye.

If I do have the procedure and have it one eye at a time, how long should I "evaluate" the outcome of the first eye? Obviously, if any halos go away or are unnoticeable in 2 months, I could go forth with the second eye. But at what point in time should I consider halos to be a permanent rather than a residual side effect? Also, would a LASIK surgeon listen to me (an opthalmological layman) as to what laser and/or size ablation zone I should have?
Jeff