Any options for pupils that dilate beyond treated area?

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Any options for pupils that dilate beyond treated area?

Postby socalmatt » Fri Jul 06, 2007 1:42 am

I've had Lasik done back in 1997. At the time, the doctor did not thoroughly check to see how much my pupils dilate in the dark, even though this was one of my major concerns that I asked about, pre-treatment. His explanation, after the fact, was based on my eye color (brown), I was less likely to dilate beyond the treated area than a person with lighter color eyes.

Needless to say, I've been very patient (10 years) for the doctor to help me with my problem. Every time I call to check whether something can be done about my condition, he informs me the only way to correct my condition is via custom cornea. But he also tells me that since I've had Lasik done in the past, the custom cornea option has not been approved by the FDA for patients, like myself, who've had Lasik before.

Therefore my question is:
1) Is my doctor giving me the runaround and is his explanation/excuse credible?
2) Are there options to correct my pupil dilation issue with newer vision correction techniques that have been introduced over the past decade since my procedure?

Thank you in advance for any feedback.
Matt
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Re: Any options for pupils that dilate beyond treated area?

Postby JPD » Fri Jul 06, 2007 4:28 am

socalmatt wrote:His explanation, after the fact, was based on my eye color (brown), I was less likely to dilate beyond the treated area than a person with lighter color eyes.


Hmm, I've never heard that one before. It sounds ridiculous in fact. Then again, that doesn't make it false.

socalmatt wrote:Needless to say, I've been very patient (10 years) for the doctor to help me with my problem. Every time I call to check whether something can be done about my condition, he informs me the only way to correct my condition is via custom cornea.


I don't know how custom lasik would help with this problem. What you need is a larger fully corrected ablation zone, and most custom wavefront guided systems default at around a relatively small 6mm. How big are your pupils, by the way?

socalmatt wrote:But he also tells me that since I've had Lasik done in the past, the custom cornea option has not been approved by the FDA for patients, like myself, who've had Lasik before.


Not sure about that one. Doesn't sound right to me, but Glenn can answer that one.

socalmatt wrote:Therefore my question is:
1) Is my doctor giving me the runaround and is his explanation/excuse credible?


Whether he is or not, get a second opinion from a corneal specialist, just be on the safe side. It should be covered by medical insurance.

socalmatt wrote:2) Are there options to correct my pupil dilation issue with newer vision correction techniques that have been introduced over the past decade since my procedure?


I would think a machine that creates a larger ablation zone, like the Allegretto, which is 7.5mm. It's not wavefront guided but wavefront optimized.
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Re: Any options for pupils that dilate beyond treated area?

Postby LasikExpert » Fri Jul 06, 2007 5:03 am

socalmatt wrote:His explanation, after the fact, was based on my eye color (brown), I was less likely to dilate beyond the treated area than a person with lighter color eyes.

That is a bit of a red herring. No matter what the iris color, the natural dilation of the pupil is what needs to be measured and considered. See Lasik pupil size for details.

socalmatt wrote:Every time I call to check whether something can be done about my condition, he informs me the only way to correct my condition is via custom cornea.

Not necessarily correct on all counts. A Lasik enhancement would not be limited to the Alcon CustomCornea platform. All other lasers could be used - although not all may be appropriate.

socalmatt wrote:But he also tells me that since I've had Lasik done in the past, the custom cornea option has not been approved by the FDA for patients, like myself, who've had Lasik before.

Another red herring. The excimer laser does not need FDA approval to be used for retreatment. Lasik enhancement is an off-label use of the laser, which is absolutely appropriate under scope of medicine regulations.

socalmatt wrote:1) Is my doctor giving me the runaround and is his explanation/excuse credible?

I'll let others debate this one.

socalmatt wrote:2) Are there options to correct my pupil dilation issue with newer vision correction techniques that have been introduced over the past decade since my procedure?

Possibly yes. You need a second opinion from a corneal specialist who is familiar with current laser eye surgery techniques and limitations.
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Thank you JPD and Glenn

Postby socalmatt » Fri Jul 06, 2007 10:53 pm

Thank you for your responses. I've never received a straight answer from my doctor before and always thought the answers he gave me were a bit bogus as well.

I'll plan on making an appointment with a corneal specialist to get an assessment of my options.

As for your question regarding how much my pupils dilate in the dark... I'm not sure, although I'm pretty sure it's over 6mm. When I've had checkups with opthalmologists, they've remarked how much my eyes dilated in the dark, even without the dilation drops.

Also, I have to keep the lights on when watching a movie at home since a blurry halo forms around images on the screen, such as credits against a black background at the end of a film. Basically, my condition makes any dark location tough to deal with.

I'll share my findings and progress on this site as it happens, so others who suffer the same condition can possible get some insight.

Thanks again for your time and helpful responses.
Matt
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Postby LasikExpert » Sat Jul 07, 2007 5:30 am

Discuss with your doctors if Alphagan P is appropriate. This is a glaucoma eye drop medication that has the side effect of making the pupils smaller. You may be able to use a drop when you are going to the movies, driving at night, etc.

A similar medication is pilocarpine, but pilo is much stronger. The Alphagan P tends to be better tolorated.
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