Vincent wrote:Was there any way I could have had a larger optical zone with a different laser? I have read that Allegreto goes out to 8.00 (optical zone). i realize that LASIK would not be suitable, but could I have had PRK with an Allegreto laser coupled with the use of mitomycin c to reduce the chance of haze?
Lasik enhancement would likely be appropriate. You may also be able to have PRK on the Lasik flap. Undoubtedly Mitomycin C (MMC) would be used to reduce the probability of corneal haze with PRK on the flap.
Vincent wrote:Was I doomed from the start?
Most certainly you were at a higher risk of problems than someone with a lower prescription to be corrected. The large pupils is something to be considered (read Lasik and large pupils
), but I'm actually more inclined to think the problem relates to how flat your corena is after surgery. The problem of halos in daytime indicates that your cornea may be very flat and that is contributing to your problem. A larger pupil just means more light through a flat cornea is reaching the retina and is "seen".
Vincent wrote:Should I have been turned away or at least counseled and told that I am a high risk candidate because of my large pupils and large correction?
You absolutely should have been advised that you had a higher than normal risk of vision difficulties, but at the same time there have been many patients with large pupils and large corrections that do not have halo problems.
Vincent wrote:Would a Visian ICL been more appropriate? I realize this is a more invasive surgery, but does it counter the problems that LASIK/PRK presents to people with large pupils and large correction needs?
As a general rule a phakic intraocular lens (PIOL)
is a good alternative to Lasik for someone with high refractive error, but much would depend upon the unique properties of your eyes. I suspect edge glare from the PIOL would have been a real risk with such large pupils.
Vincent wrote:What are my options now?
The first is to determine if the residual refractive error can be fully corrected and if this reduces or eliminates the problems. Even a 0.50 D refractive error can cause blur that may present as halos around light sources at night. Soft contacts, glasses, or rigid gas permeable (RGP) lenses should be tried, and in that order. If you can get relief, then enhancement surgery may resolve the problem.
You can have Lasik on the flap that is as large as the flap itself, but regular enhancement surgery is not necessarily going to be that helpful if the problem cannot be corrected with lenses first.
If your corneas are especially flat, an RGP may help or even laser surgery to add curvature to the cornea. Whatever you do, get a second opinion from a competent doctor first.