Starburst and halo- Share your experience

[vk]

I had lasik six weeks ago and still experiencing starburst and halo. vision is fine though and has stopped fluctuating. I had minor dry eyes problem before lasik and eyes were 8:00 with 1.5 astigmatism. I thought it would give us same ray of light :) for people like me , if there was a thread for night vision complications where everybody can share their experiences and time it took to resolve such complications.

[ptmccain]

I'm on day six since my surgery and just had my first "night time" driving experience early this morning. I was surprised, pleasantly so.

I can see a "halo effect" but nothing unbearable and no starburst effect.

Had correction in left eye for close-up, distance in right.

So far, so good on the night vision issues.

In fact....using my "distance eye" I can definitely notice that I can see more stars in the dark night sky! Cool.

[dreamer1107]

Hi vk :D
I actually posted on this issue a week or so ago, because I'm having terrible starbursts, halos and some other troubling night issues. I actually had a PRK enhancement to try to fix the night vision issues that I got from my initial laser surgery (PRK is like lasik, but instead of lasering beneath a flap, they laser the surface of the eye--takes a little longer to heal).

I'm now into my 5th week post op and not seeing much improvement so I'm getting pretty worried that this surgery won't fix my problems.

I'd love to hear when/if your night vision problems start to improve (hopefully will give me some hope too!). How bad are your symptoms? (larger or small starbursts/halos, etc?)

[bexensol]

"Your pupils are large, but within LASIK limits", my Dr informed me, while determining my suitability for the surgery. That was early April 2007, and late April 2007 I went ahead with the procedure, being an 'excellent' candidate.

My eyes were 3.75 and 4.5, with no astigmatism. CustomVue Wavefront was used, alongside a VISX laser. My daytime vision is excellent, and other than dryness when working in an air-conditioned environment, I can't complain.

Night-time is another matter. Up until now my Dr has been suggesting my dry-eye condition to be the cause of the starbursts I see at night. These are not debilitating, but certainly are a distraction. Neither punctum plugs nor a 3 month course of Restasis has had any effect (nor liberal amounts of lubricating eye drops).

This month (March 2008) I thought back to those initial words from my Dr regarding my pupil size. Some basic self-tests suggest that a switch from adequate light conditions to low-light conditions brings about the 'fuzz' surrounding lights. My current theory is my pupil dilation is greater than the corrective surgery allowed for.

I've read the article about pupil size on this site, and I'll be going to my Dr this coming Wednesday (19th) to mention my theory, and inquire into what my options are. Reading around, it appears I may be able to take a prescription eye drop to reduce pupil size at night time, with potential side affects, or explore 'Complex Wavefront Retreatment'. This treatment may be able to treat my shortsightedness up to my full dilated pupil size.

PRK appears to have the potential to cause 'haze' if applied to post-LASIK eyes, which if the possibility exists that may affect my day-time vision, I'd prefer not to take that risk.

This is actually 'strike 3' for my LASIK surgeon:
1. I was not informed I may lose sight during the IntraLase phase. That was a shock.
2. I was not informed I may smell burning, eye burning, during the operation. I did.
3. My large pupils, and the potential risks involved, were not adequately described to me.

I would prefer to avoid further surgery, especially if I have to have my eyeballs vacuumed again. I've read the suggestion that the existing corneal flaps can be used again, rather than making new, eliminating the need for suction. That would bring about some comfort, but I need to have that confirmed.

I'm also going to ask my LASIK surgery for a full copy of my records, to determine the measurement they took for my pupils against what their surgery can correct up to.

I'll provide an update later this week post Dr visit to discuss my options to reduce the starbursts.

[LasikExpert]

Reading around, it appears I may be able to take a prescription eye drop to reduce pupil size at night time, with potential side affects,

The eye drop is Alphagan P, which is a glaucoma medicine that has the side effect of causing the pupils to reduce slightly. Unless you have an allergy to Alphagan P, other potential problems are few.

...or explore 'Complex Wavefront Retreatment'. This treatment may be able to treat my shortsightedness up to my full dilated pupil size.

The largest optical treatment zone in wavefront-guided mode is 6.5mm, smaller if there is astigmatism correction. A wavefront optimized treatment may be a more appropriate alternative, depending upon the size of your naturally dilated pupils and if Alphagan P or similar helps your vision problems.

PRK appears to have the potential to cause 'haze' if applied to post-LASIK eyes, which if the possibility exists that may affect my day-time vision, I'd prefer not to take that risk.

Mitomycin C is applied to the cornea when PRK is used after Lasik virtually halts all cormeal haze formation. Mitomycin C is strong medicine, but appropriate when needed and PRK on the Lasik flap pretty much requires Mitomycin C.

1. I was not informed I may lose sight during the IntraLase phase. That was a shock.

When the suction ring is applied to the eye to create the Lasik flap (mechanical or laser created) the intraocular pressure within the eye elevates enough to cause a temporary black-out. I'm quite surprised this was not in the normal preoperative videos, informed consent, or mentioned by the doctor and/or staff as the suction ring was applied. Yes, I imagine that was quite shocking.

2. I was not informed I may smell burning, eye burning, during the operation. I did.

The excimer laser used for Lasik and PRK does not actually burn the cornea. It causes a reaction that releases the molecules that hold together the cells of the cornea. These cells fly away from the cornea, and that is what you are smelling. It very much has a burnt hair or burnt tissue smell, but the cornea actually only raises about 11 degrees and that is only because of the friction of the cells banging into each other as they escape the cornea.

3. My large pupils, and the potential risks involved, were not adequately described to me.

What I have found is that doctors and staff are good at saying, "You have large pupils, there may be a night vision problem, but in my opinion the risk is not very elevated." Or you may hear, "You may have a bit of halos around lights at night after surgery."

What you apparently did not hear was, ""You may have a bit of halos around lights at night after surgery and that means you may not be able to drive at night."

One statement informs. The other statement informs and informs the consequences as they may relate to the patient.

I would prefer to avoid further surgery, especially if I have to have my eyeballs vacuumed again.

Vacuum would not likely be required. The Lasik flap can be lifted even years after surgery. PRK on the Lasik flap would not require the flap to be lifted.

I'm also going to ask my LASIK surgery for a full copy of my records, to determine the measurement they took for my pupils against what their surgery can correct up to.

There is nothing wrong with getting a copy of your records (give them a few days to copy everything), but unless you have a doctor look at them you are not likely to see clearly what was the pupil size measurement. If you want to know the size of your naturally dilated pupil as reported in your chart, ask your doctor's staff to review the documentation and explain how the measurement was taken (Colvard in no light, ruler in low light, scan, etc.) and what were those measurments.

[bexensol]

Glenn,

I appreciate your input. I'm glad to hear a vacuum is unlikely to be required should I require/decide for additional surgery. Regarding my whole LASIK surgery experience, the bedside manner provided by the staff was quite lacking in my opinion, and others (who have been through the treatment or not) were quite horrified by my account.

Another aspect I didn't mention was the inadequate pain medication/management I received. Once the numbing drops wore off post surgery, I experienced 4-5 hours of 'hot poker in eyes' syndrome. The prescribed pain medication was obviously ineffective, and the valium had no effect. Overall, to others I'd recommend LASIK, but I couldn't recommend the clinic that performed it (and we're talking a well established Chicago institute).

As mentioned, my day-time vision is excellent, and although I have the halos, I am not disappointed, nor upset with the outcome. I appreciate there are risks with any surgery, and have allowed the time to find out if my eyes would heal and the halos disappear. Since it has nearly been a year now, I believe it is time to move on from dry eye to other causes.

I have options to explore with my Dr, and I'll suggest Alphagan P to him. Once concern with such use of this drug, is that although it may reduce the halo effect, will it actually provide me enough light to see during low-light times of the day. Not having prior experience with this, but considering others are obviously using it, I imagine night driving and other similar activities are still possible while using the drops.

Thanks again, and an update will be forthcoming this week.

[LasikExpert]

Once concern with such use of this drug, is that although it may reduce the halo effect, will it actually provide me enough light to see during low-light times of the day.

Pilocarpine is an eye drop for reverse dilation that is a bit harsh on the eyes. The pupils snap shut nearly completely and stay that way. Alphagan P's effect on pupil size is much gentler. It seems to reduce their size proportionately, rather than to an extreme. Your eyes can still dilate, but they don't dilate as much.

You know if it is an acceptable effect if/when you try it.

[bexensol]

*Update Wed 19th 08 Post Dr appointment*

Dr confirmed eyes are healthy, and I have 20/15 vision. I expressed concerns with night-time halos/starbursts, pupil size, mentioned Alphagan. Dr has asked that I make appointment with lasik clinic/surgeon to discuss options, including potential trial/prescription of Alphagan by surgeon.

Dr also mentioned my pupils were measured at 9mm pre-lasik. He stated CustomVue, which I had, can accommodate this pupil size.

Next update after appointment with lasik clinic!

[floatanddry]

9mm are very large pupils. I've am not sure of any laser that deals with pupils that large in the US.

Alphagen may be an option, or RGP lenses could be a last resort if needed to try and help correct around your large pupils for night vision.

In my opinion you should have been informed better on the risks with your large pupils.

[bexensol]

9mm are very large pupils. I've am not sure of any laser that deals with pupils that large in the US.

Alphagen may be an option, or RGP lenses could be a last resort if needed to try and help correct around your large pupils for night vision.

In my opinion you should have been informed better on the risks with your large pupils.

Floandanddry - I tend to agree regarding being educated on the risks associated with my large pupils. Looking back I am surprised this wasn't even commented on by my lasik surgeon.

Per this site: http://www.visx.com/professionals/news_ ... _12_15.php
"The safety and effectiveness of wavefront-guided LASIK surgery has ONLY been established with an optical zone of 6 mm and an ablation zone of 8 mm for myopic astigmatism, and an optical zone of 6 mm and an ablation zone of 9 mm for hyperopic astigmatism."

So, 9mm is possible, it would seem, although only in the case of hyperopic astigmatism, which no Dr has mentioned I suffer from. I guess someone to decode that paragraph would be helpful.

It goes on to say:

"It is possible, after wavefront-guided LASIK treatment, that patients will find it more difficult than usual to see in conditions such as very dim light, rain, snow, fog, or glare from bright lights at night. Visual performance possibly could be worsened by large pupil sizes or decentered pupils. Pupil size should be evaluated under mesopic illumination conditions."

I feel I may of been at the limits of lasik correction ability, but it was not presented to me as such, and the risks associated.

And if anyone likes irony, have a read of the first four paragraphs of that URL, and cross reference with my [Sun Mar 16, 2008 12:05 am] post in this subject.

Back to the Lasik Doc on Tuesday morning, with some serious pupil related questions.

[LasikExpert]

Dr also mentioned my pupils were measured at 9mm pre-lasik. He stated CustomVue, which I had, can accommodate this pupil size.

In this instance, "accommodate" is a relative term. The largest fully corrected optical ablation zone for the Visx in wavefront mode is about 6.0mm and is a bit smaller if there is astigmatism correction. The laser can "blend" out to a larger treatment area, but it is fully corrected with a wavefront map.

I suspect that your pupils were measured with a Colvard pupilometer. This measurement is taken in total darkness using invisible ultraviolet light, therefore your pupils will be larger than they would be in low, but visible, light. The difference is about 1.0mm for most people. Your pupils would still be larger than normal at 8.0mm, but may not actually be 9.0mm.

[bexensol]

* Update Tuesday April 1st 2008. Nope, no jokes. *

Had appointment with Lasik Dr today. All staff I encountered were surprised I had halos/starburst at night time. 'Very surprised to hear that' mentioned the Dr.

All eye-related tests came back with great results. Healthy, well healed eyes, better than 20/20 vision.

Interestingly, after mentioning pupil size as a potential cause to nurse performing tests, she scanned the notes and read aloud 'pupils measured at 7.5mm in dim light conditions before Lasik op'. Anyone reading my previous posts will see that I've been measured to 9mm pupil diameter.

Personally, I am more and more convinced this is a pupil size related issue, although my Lasik Dr was hesitant to provide any drops to reduce my pupil size. Instead he has prescribed lubricating eye drops for the next month, and then for me to return in four weeks to see how I am doing. He did see that one of my eyes was dry under examination, although I personally feel I am able to distinguish between sight that is distorted via dryness against that which I believe to be related to pupil size.

My Lasik Dr also mentioned an enhancement may be an option. I expressed that I did not wish to risk my day time vision. He was sympathetic to this. He asked for another wavefront diagnostic to be carried out, which was also performed today. This was a surprise to the technician, and I got the impression she isn't often asked to perform this test after Lasik and better than 20/20 vision is gained. Technician said wavefront analysis looked good, and she actually asked me "do the starbursts/halos bother you that much?". A single word response answer - Yes.

Current mood is frustration. I simply want to test the theory that reducing my pupil diameter at night will alleviate the problem. My eye Dr previously mentioned he'd see he can get me a sample of Alphagan, and I've left a message with him to see if he's been able to. I'm also tempted to see if there are other sources I can obtain this drug from just to prove a point. I feel I'd rather be paying for a prescription of Alphagan than wetting drops.

If anything signifcant occurs between now and my next Lasik Dr appointment, I'll provide an update. Such as obtaining and trialling Alphagan.

[croanster]

Just wondering if there is any major difference between Alphgan and Alphagan P. My doc gave me a script for Alphagan (no P) and it seems the “P” version is not available in Australia.

It definitely works in my case. Drys my eyes out a bit though.

Also, there are lots of on-line sources that supply the “P” version. If its better, I might as well get that since it’s cheaper than the one I got the script for in Aus anyway.

Thanks.

[bexensol]

Hi croanster. I did a little bit of research into this, although not conclusive. I believe the two differences may be the % of active ingredient, and that P may stand for preservative (or rather, free of preservative in Alphagan P). I wouldn't be surprised if I was corrected by someone that knew what they were talking about though :)

When you say it works, you mean your starbursts/halos experienced at night time post-Lasik are significantly reduced?

[croanster]

Ok thanks - I might see about getting some of the "P" variety once I finish the one I'm using now.

Yes - it gets rid of the starbursts completely from my left eye and reduces them to the point of not being noicable in my right eye. (right eye is much worse than left with starbursts) I also get a fair amount of 'glare' in my right eye for example reflective road signs at night. The alphagan pretty much completely gets rid of that as well.

The only drawback is that it makes my eyes feel dry for a few hours. Maybe thats the preservative? Don't know. I usually put the alphagan in, leave it for about a minute and flush my eyes out with some refresh and it seems to do the trick.