Night vision problems - pupil size??

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Night vision problems - pupil size??

Postby poolmaniac6 » Sat Dec 02, 2006 11:36 pm

I am 14 weeks post epi-lasik and have been having night and low-light vision problems. Main problem when I am driving is big time starbursting on all lights. I am also having issues when in any low light light environment. These have been overall fuzzy vision, ghosting and starburst among other things. My surgeon wanted me to try Alphagan-P drops which I have been using the past few nights. This has helped quite a bit with all of my problems. I still have slight starbursting to the botton of headlights but not nearly as bad as before. My fear is that my pupils were not measured correctly. They used a measurement of 5.5 for surgery. I asked my surgeon about this last week and he tested them again using an instrument that was not used to test them before surgery. He said they were measuring around 6.0 and that my ablation zone went out to 7.0. Am I going to have to use ALphagan drops forever?? I am wondering if my surgeon messed up my pre-surgery numbers??
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Postby LasikExpert » Sun Dec 03, 2006 10:49 am

You may have some continued improvement in vision even after 14 weeks, but it would appear that when your pupils become large, light traveling through the outer edge of your corneas is distorted, under, or overcorrected.

You may want to read about Lasik and Pupil Size, but it appears that your treatment size was equal or larger than your naturally dilated pupils.

If you are now using any medications, vitamins, or supplements that you did not use before surgery, be sure to tell your doctor. Many things can make pupils larger than normal.

Alphagan P will probably be the most appropriate workaround while you continue to heal, unless corrective lenses work.

For some people starbursts and halos from light sources may occur if they are even slightly over or undercorrected. If you are able to resolve this starbursting with corrective lenses, then the problem is limited to refractive error which may be able to be corrected with glasses, contacts, or possibly enhancement surgery. Unless your doctor specifically recommends otherwise, you may be best served by waiting to make any decisions about enhancement surgery until after the six month postop point.
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Postby peakaboo » Sun Dec 03, 2006 4:28 pm

I had customvue intrasik about 18 weeks ago, knowing in advance that I'd most likely have issues in low light. I have an appointment coming up at which time I will see if the doctor recommends Alphagan-P to treat the symptoms. I've read a study that with frequent use, this medication may for some people become less effectiveness over time, so I'd probably use it only when necessary.

I think my large pupils are contributing to my problem, but there may be other contributing causes as well. Hopefully, the doctor will do a thorough evaluation to see where I stand now that I'm 4+ months post surgery. The 1 week and 1 month post-op visits just checked my ability to read lines on an eye chart...at what point post-op are they supposed to do another orbscan or a new refractive test?

On another note...I've read that pupil diameter gets smaller with age. Have there been any studies done which quantify in any meaningful way how much smaller they get over a given amount of time (i.e. on average 1 mm/decade scotopic, etc.)? Maybe 20 years from now I'll have fewer night vision problems due to pupil being less affected by small ablation zone =)
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Postby peakaboo » Sun Dec 03, 2006 5:38 pm

Hmm, I found this page with a table relating pupil size and age. Not sure if there's any scientific basis to the values given, but the chart shows scotopic change of -1mm dia between age 40 and 50. That's promising if it's correct.

http://www.visualexpert.com/Resources/olderdrivers.html
Last edited by peakaboo on Wed Dec 06, 2006 2:13 am, edited 2 times in total.
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Postby DryEye » Tue Dec 05, 2006 7:23 pm

How do pupils (measurements, etc) come into play with lasik?
Is it possible that lasik changes ones pupil responses, especially first waking up in the morning?
Thanks
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Postby LasikExpert » Tue Dec 05, 2006 10:35 pm

We have a detailed article about Lasik Pupil Size issues that may be helpful.

Pupil response is often different in the waking hours. After deep sleep the body slows down. The pupil is usually fully dilated when first awaking and is likely dilated much more than normal during the day. It can take a while for all the parts of the body to get up and fully functional.
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night vision size - pupil size

Postby poolmaniac6 » Fri Dec 08, 2006 1:00 am

Thanks for the replies. I have been having terrible night vision the past few nights - so bad that I went to visit my surgeon yesterday. It seems that my vision gets worse as my pupils get bigger. He did a test on my pupil size again and they were at 8.5mm. The numbers used for my procedure were 5.5mm out to 7.0mm. I was told that my glasses that I used to wear before surgery were overcorrected and I am wondering if that led to an inaccurate pupil size. I can read a fuzzy 20/20 on the eye chart but that is not idicative of the issues that I am having inddors and at night. Is there any hope that my pupils will settle down??? Are there any options for better night vision if my pupils stay this big???
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Postby LasikExpert » Fri Dec 08, 2006 3:11 am

If the night vision problems just recently arrived and did not exist before, then something has changed. Illness, medications, supplements, many things can cause pupil dilation. Try to isolate the source, if there is an outside source.

Alphagan P is a glaucoma medication that has the side effect of reducing pupil size. One drop of Alphagan P in the evening is usually enough to resolve minor night vision problems. Talk to your doctor about whether or not Alphagan P would be appropriate.
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Night vision problems - pupil size??

Postby poolmaniac6 » Fri Dec 15, 2006 4:31 am

Have there actually been any long term studies on the use of Alphagan-P.? Using one drop of this has helped my night time (indoor also) issues quite a bit, but I seem to be getting flashes of light on my peripheral vision. This seems to happen only when using this drop. I still don't think that my pupils were measured accurately before surgery. My surgeon told me last week that even eating certain foods can make ones pupils smaller than normal. If this is the case it wouls seem to make sense to measure the pupils more than once. My were a 5.5mm reading that was used for my procedure. Last visit they were 8.5mm. This obviously explains why I cant see at night. I am really starting to wonder about the competantcy of the Lasik industry and the honesty of studies done. I wish I would have wondered this about 4 months ago before my cornea was blasted away by a laser. That statement just sounds wrong.
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Postby DryEye » Fri Dec 15, 2006 4:59 am

Does your flashing in the peripheal vision only last momentarily?
I notice something like this after waking up in the morning and start walking around. But, not always?
Usually for 30 seconds or so when it does occur.
Very weird - My thinking it could be pupil related or maybe something having to do with the outer edge vision where the cuts where made on the cornea??
Perhaps, the outer edge vision hasn't been corrected like the rest of the eye??
I didn't have this going on before lasik and no one I have asked seems to have an answer except for if it only occurs after waking and not during the day don't worry.
I hear you so far on responses you have gotten post lasik.
This site helps as your persistence in getting the right answers.
Get a second opinion or third from a good corneal doc. & let us know.
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