Expert Commentary: Michael Rosenberg, M.D. 10/22/2009

One of the controversies in LASIK surgery is whether a larger pupil size in the dark prior to corrective surgery is associated with more post-operative night vision issues. This sounds logical, since a larger pupil will result in incoming light entering a larger area of aberrations. Despite the apparent logic, studies about the outcomes of patients with large pupil diameters (8 mm or more in patients receiving custom treatment, 7 mm in patients receiving conventional treatment) have shown that larger pupil diameter is not significantly associated with post-operative satisfaction. The reality is that the uniqueness of a individual patient’s eye, may have more to do with post-operative night vision phenomenon than pre-operative pupil size in patients having uncomplicated LASIK.. 

With this in mind, what should a typical LASIK patient to expect to hear from his/her surgeon during the informed consent?  They should be told that there will be an immediate but temporary increase in night vision issues. They should be told of the expectation that the halos and starbursts will steadily decrease and only rarely be severe enough to interfere with night driving.  Patients with pupil sizes in the dark greater than 8 mm may be at a slightly greater risk for having more post-operative night vision phenomena and should consider custom treatment. Finally they should be told that the most common causes of persistent night vision phenomena is temporary dryness and/or incomplete correction of the initial eyeglass correction, both of which can be corrected.

What the surgeon should expect is that an informed patient will make the best decision for himself or herself and that an uninformed patient is destined to be unhappy.

Michael Rosenberg, M.D.