pupil size and halo

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pupil size and halo

Postby lyann » Fri Jul 31, 2009 7:35 am

I'm thinking to have a lasik surgery for my myopia (-2 D). The optometrist want my to get a 2 time more expensive type of lasik because of my pupil size (8.6mm). I recently reed 2 scientific papers who report that pupil size do not mather for the risk to have halo at night, even for pupil size more than 7mm and other risks factors combine (Sphere 5 D, Sphere 5 D and Optical Zone, Age 50 yrs and older). Here the reference of the article, Pop, M. and Payette, Y. (2004). Risk Factors for Night Vision Complaints after LASIK for Myopia. American Academy of Ophthalmology. 2004; 100:3-10.
What is the current opinion of the lasik surgent at the moment of that kind of study? I reed in your web site that pupil size and optical zone is still consider a risk factor, is it because other paper find the contrary? Did I need to get a lasik that cover all my pupil size in order to reduce the risk of halo?
Thanks a lot!
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Re: pupil size and halo

Postby LasikExpert » Sat Aug 01, 2009 1:36 am

lyann wrote:I recently reed 2 scientific papers who report that pupil size do not mather for the risk to have halo at night, even for pupil size more than 7mm and other risks factors combine (Sphere 5 D, Sphere 5 D and Optical Zone, Age 50 yrs and older).


Your takeaway message from this study accurate, but incomplete. It is not that pupil size does not matter. It is that pupil size is not a reliable predictor of who will and who will not have low light vision problems like halos. Some people with large pupils do not have night vision problems, and so it is not accurate to say that large pupils equals halos. A factor is the amount of needed correction. Pupil size seems to be less important the lower the amount of correction needed, and inversely pupil size is more important the larger the amount of required correction.

If halos present, pupil size regulates their severity. Reducing the size of the pupil reduces the halo effects.

So, before surgery pupil size is a poor predictor, but if halos do exist after surgery, reducing the size of the pupils can reduce halo symptoms.

As we say in our article about Lasik and pupil size, the safest route is the fully treated area to be equal to or larger than the size of the naturally dilated pupils in a low light environment. Anything else may not guarantee halos, but would increase the probability of problems.
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Re: pupil size and halo

Postby lyann » Tue Aug 04, 2009 7:37 pm

Thanks you very much for your answer. I talk to my surgeon and he said that it was ok for me to have the standard laser. That it was just a little bit more risky than the zyoptic.
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Re: pupil size and halo

Postby nemesis63 » Mon Nov 09, 2009 2:07 am

lyann wrote:Thanks you very much for your answer. I talk to my surgeon and he said that it was ok for me to have the standard laser. That it was just a little bit more risky than the zyoptic.


My pupil size is 8mm and i'm having all gash effects and dry eye (starburst even at daylight). If you can see clearly with your glasses why would do it? Believe me doesn't worth it. 1 of the 3 lasik patients have side effects and 1 of the 3 have it for good. I did it because i didn't know/told any side effects of lasik before surgery. I personally don't recommend it.
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Re: pupil size and halo

Postby LasikExpert » Tue Nov 10, 2009 7:29 pm

nemesis63 wrote:My pupil size is 8mm....


An 8.0mm naturally dilated pupil in dim light, but with enough light to allow vision, is extremely rare. It seems much more likely that this measurement is pharmaceutical induced or with use of a Colvard pupilometer or similar infrared device, which measures pupil size in total darkness. Total darkness pupils tend to be about 1.0mm larger than a naturally dilated pupil in an environment where one would be expected to be able to see.

Even a large naturally dilated pupil does not automatically mean that Lasik is contraindicated. People with large pupils have Lasik without night vision problems all the time, however there are other considerations such as amount of tissue removal, steepness of cornea, type of refractive error, etc. that need to be considered. Those interested may want to read our article on large pupils and Lasik.

nemesis63 wrote:...and i'm having all gash effects and dry eye (starburst even at daylight)


"GASH" is short for glare, arc, starburst, and halo. Having starbursts tends to indicate a rough corneal surface, which is consistent with dry eye. Starbursts in daylight is very consistent with a rough corneal surface and dry eye. If you have not already, read our article about dry eye treatment after Lasik.

nemesis63 wrote: If you can see clearly with your glasses why would do it?


The obvious goal is to be rid of glasses, but that is too simple of an answer. The real motivation for Lasik is often multifaceted and may include an individual's perception of appearance, participation in sports, or demands of employment. There are probably as many individual justifications to have Lasik as there are individuals.

nemesis63 wrote:Believe me doesn't worth it.


The most that one can expect from Lasik is the convenience of a reduced need for corrective lenses. To gain that convenience, one must accept some level of risk. The level of risk is dependent upon the individual's eye health. The acceptable level of risk is dependent upon the personality of the individual. Some people skydive. Others won't fly in a commercial airliner. Whether or not to have Lasik is a very individual decision.

nemesis63 wrote:1 of the 3 lasik patients have side effects and 1 of the 3 have it for good.


Our organization developed and administrates the USAEyes Competence Opinion Relative to Expectation (CORE) vision correction surgery patient survey. Of those who responded:

    99% report quality of life as expected, better, or much better
    98% day vision as expected, better, or much better
    98% no complications or issues are seldom problematic
    98% would recommend surgery to family and friends.
    97% would have surgery again, knowing what they know now
    96% wear corrective lenses as often as expected, less, or much less than
    expected
    96% report postop vision without lenses as expected, better, or much better
    than expected when compared to preop vision with lenses
    96% report overall quality of vision as expected, better, or much better than
    expected
    91% no complications at any time
    91% night vision as expected, better, or much better
    7% complications seldom problematic
    – 91% would have surgery again
    2% complications frequent or always problematic
    – 22% would have surgery again

The results of the USAEyes CORE survey strongly dispute your contention that 33.3% of Lasik patients have a permanent complication. You can see more detailed information on our Lasik Results page.

nemesis63 wrote:I did it because i didn't know/told any side effects of lasik before surgery.


The only reason you had Lasik was because you didn't know that microsurgery on the eyes had risk? You mean it wasn't because you wanted a reduced need for corrective lenses? It wasn't because you thought you might look better without glasses? It wasn't because you didn't like dealing with contacts? It wasn't because corrective lenses interfered with your desired lifestyle?

I have no doubt that you firmly believe your statements to be truthful, however virtually every patient I have ever encountered has received an informed consent form that lists many potential complications of Lasik. Most practices have informed consent videos with a test afterward, and require the patient initial key components of a written informed consent. In addition there is this website and many other resources on the Internet that define in great detail potential compilations of Lasik. There are scores of individual websites and blogs that discuss personal Lasik experiences both good and bad.

There may be reasonable argument that one particular doctor's informed consent process is deficient, but the proclamation that a person did not know or was not told any side effects of Lasik before surgery is very difficult to believe. Even plain old common sense would tell you that surgery has risks.

nemesis63 wrote:I personally don't recommend it.


That is key. An individual's recommendation or lack of recommendation is valuable insight into the potential outcome of Lasik, but it is based upon that individual's personal experience. Different people have different experiences. Different Lasik candidates have different desires and different expectations of result. One would not expect to see well if one borrowed anther's contact lenses. Neither should one decide whether or not to have Lasik - or any elective surgery - based solely upon the experience of one or two other people (good or bad). Only after a comprehensive evaluation by a competent surgeon can someone even start to know whether or not Lasik is appropriate.

I'm sorry that your personal experience with Lasik has been so bad. I hope that you find information on our website that can help you manage your problems. I realize all too well how frustrating a bad Lasik outcome can be and the distrust that can be a result, however your reported result is clearly an exception and not the rule. It is an important exception that needs to be considered by anyone thinking about Lasik, but it is only one piece of information, not the entire decision.
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Re: pupil size and halo

Postby Anyman » Fri Nov 13, 2009 4:06 am

LasikExpert wrote:
nemesis63 wrote:My pupil size is 8mm....



nemesis63 wrote:I did it because i didn't know/told any side effects of lasik before surgery.


The only reason you had Lasik was because you didn't know that microsurgery on the eyes had risk? You mean it wasn't because you wanted a reduced need for corrective lenses? It wasn't because you thought you might look better without glasses? It wasn't because you didn't like dealing with contacts? It wasn't because corrective lenses interfered with your desired lifestyle?

I have no doubt that you firmly believe your statements to be truthful, however virtually every patient I have ever encountered has received an informed consent form that lists many potential complications of Lasik. Most practices have informed consent videos with a test afterward, and require the patient initial key components of a written informed consent. In addition there is this website and many other resources on the Internet that define in great detail potential compilations of Lasik. There are scores of individual websites and blogs that discuss personal Lasik experiences both good and bad.

There may be reasonable argument that one particular doctor's informed consent process is deficient, but the proclamation that a person did not know or was not told any side effects of Lasik before surgery is very difficult to believe. Even plain old common sense would tell you that surgery has risks.



What the "informed consent" papers say and what the doctors say is proving to be two different things. Without the doctor & his staff saying that all the informed consent stuff is "for the lawyers" and "don't worry, you'll be all right", who would undergo this procedure? Wish I didn't....
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Re: pupil size and halo

Postby LasikExpert » Fri Nov 13, 2009 6:59 pm

It is not likely that a doctor is going to personally use in general conversation the language of an informed consent document, but that document, the videos, the written tests, etc., are all coming from the doctor. They are all saying that risks are involved. It is the doctor's responsibility to provide the informed consent. It is the patient's responsibility to heed its warnings.

Your situation is an excellent cautionary tale. No one should dismiss the informed consent as anything but what it is - a contract with the patient that the risks are understood. That does not help your situation, but others reading about your situation may help them.
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Re: pupil size and halo

Postby Anyman » Sat Nov 14, 2009 4:32 am

LasikExpert wrote:It is not likely that a doctor is going to personally use in general conversation the language of an informed consent document, but that document, the videos, the written tests, etc., are all coming from the doctor. They are all saying that risks are involved. It is the doctor's responsibility to provide the informed consent. It is the patient's responsibility to heed its warnings.

Your situation is an excellent cautionary tale. No one should dismiss the informed consent as anything but what it is - a contract with the patient that the risks are understood. That does not help your situation, but others reading about your situation may help them.



True, but when a patient like me SPECIFICALLY asks him if I am at risk for night vision issues and add further that I do NOT want the procedure if there is a risk, yet am assured to the contrary and told even afterwords that they "will" go away then I have a problem with that. The forms say one thing, but the answers to my very specific, detailed and probing questions about risks were rather different. That is what I find so troubling and what I will pursue with a ferocious tenacity not soon forgotten, especially since I am now hearing much the same from other people similarly afflicted from many places and with different doctors. Do you recall the saying often attributed to General Yamamoto about having "awakened a sleeping giant"? Much the same applies here, modesty put aside. My "informed consent" was based on the answers received to the very specific and deliberate questions asked. Doesn't sound so "informed" in retrospect. Saying one thing and then hiding behind a lengthy set of papers is neither fair nor honorable. If I have to live with this for the rest of my life then shouldn't the reverse also be true? Why should I alone bear this burden?

While I ruminate on that I shall continue to seek a resolution. Even now I'd prefer a fix to other, less pleasant alternatives. Posts like these & my research thereon are my good faith effort. If unsuccessful.............
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Re: pupil size and halo

Postby LasikExpert » Sat Nov 14, 2009 5:52 pm

Tread carefully as you can create a self fulfilling prophecy. I have met too many people who refuse to use techniques and treatmetns that will resolve their problems solely because of anger and mistrust that can build in a situation like yours. Loss of faith in the doctor is one thing, but loss of faith in all medicine provides little relief.
Glenn Hagele
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Re: pupil size and halo

Postby Anyman » Sat Nov 14, 2009 11:42 pm

LasikExpert wrote:Tread carefully as you can create a self fulfilling prophecy. I have met too many people who refuse to use techniques and treatmetns that will resolve their problems solely because of anger and mistrust that can build in a situation like yours. Loss of faith in the doctor is one thing, but loss of faith in all medicine provides little relief.


I have not given up and will keep searching for a fix. But, if I do not then it is not appropriate for me to want them to share my pain, so to speak? Why should I alone bear this burden? I may be old fashioned, but when a man gives me his word I expect him to abide by it. Failure to do so has consequences which have yet to be determined. i am now searching for other doctors & venues to see what I can do.

Having been burned once, so to speak, I am now quite gun shy. Who do I trust? The man I did trust is supposedly quite reputable and considered skilled. How do I know any subsequent procedures won't make things far worse? In short, how do I find a fix & how do I know it won't make things worse?
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