Lasik and large pupils

Discussion in 'Laser Eye Surgery' started by jonesbr, Dec 21, 2003.

  1. jonesbr

    jonesbr Guest

    Good evening!

    With the advent of "CustomVue" LASIK correction and the advertised
    success rates associated with it, I've finally started to evaluate my
    suitability for LASER eye correction. My myopia and astigmatism are
    both comparatively mild (under -3.5 and -1.05 diopters in both eyes),
    but I do have larger than normal pupils (over 7.0 mm). This data is
    from one of the initial CustomVue consultations. The system used in
    this proceedure is the VISX Star S4 LASER with the CustomVue trimmings
    (Orbscan II, etc.).

    The VISX Star S4 LASER has a correction field of 6mm and a blend field
    of 8mm. Thus, in low light, part of the light passing through my 7+
    mm pupil will be less than fully corrected and there is some
    possibility of halos due to this undercorrection. During this initial
    consultation, I spent 45 minutes talking to the surgeon that would do
    the proceedure (which apparently isn't as common as I thought). This
    surgeon was highly recommended by co-workers and I was reasonably
    impressed with his answers to all my questions. His feeling, based on
    previous experience and the smoothness of the blend zone of the Star
    S4 laser, was that the difference in correction zone and my low-light
    pupil diameter was not a serious source of concern. (A greater level
    of testing is done during the actual 2 hour pre-op exam, so neither
    one of us had all available information.)

    I will be talking to additional surgeons, but can anyone with larger
    pupils that has undergone LASIK with a Star S4 LASER (CustomVue or
    not) provide any comments on how much of an issue this might be? I've
    done quite a bit of web crawling, but does anyone have any pointers to
    relevant sites? Are other LASER systems (surgical skill not
    withstanding) more suited to people with larger pupils?

    Many thanks to all!

    jonesbr, Dec 21, 2003
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  2. I'm not sure which one is the customvue, but you can look here.

    Is it this one?

    Look in part 2, but consider these results to be the best possible
    results with 6mm pupils only (Unless it explicitly states otherwise).

    Just my lay person opinion based on what's happened to me and talking
    with others and reading for years on the subject- not a doc. Note
    that these results are likely done under the most ideal conditions
    where the patients are deliberately cherry picked for best possible
    results via rigorous prescreening procedures far and above those done
    in standard clinical practice. Then factor in that the Doctors can't
    "observe" all the problems that results and patients on average tend
    to be happy with vision far inferior (how much no-one knows) to what
    they had before surgery.
    lasik advocate with flap melt, Dec 22, 2003
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  3. If you do a search of this newsgroup you will find some very heated
    debates about pupil size issues.

    The safest route is for the optical ablation zone (full correction) to
    be equal or greater than the size of your naturally dilated pupils in
    a low light environment. If the optical zone is smaller than the
    pupil, the probability of night vision problems is at issue. What
    greater risk exists (if any) is not reliably predictable. There are
    people who have similar circumstances as you who do not have night
    vision problems, but then there are those who do.

    There are other lasers that have the ability to create a larger
    optical ablation zone, however if you desire to keep with a
    wavefront-guided ablation, you will find the size of the optical
    ablation zone limited. In the future, you can expect approval of
    lasers with larger parameters.

    Glenn Hagele
    Executive Director
    Council for Refractive Surgery Quality Assurance
    glenn dot hagele at usaeyes dot org

    I am not a doctor.
    Glenn Hagele - Council for Refractive Surgery Qual, Dec 22, 2003
  4. jonesbr

    Dr. Leukoma Guest

    A relatively low amount of myopia and using a blend zone will lead to fewer
    night vision disturbances than having a larger amount of myopia and not
    using a blend zone, but it would be more desirable to match the pupil and
    ablation zone diameter. Perhaps you might want to get another opinion from
    someone using the Alcon system.


    wrote in
    Dr. Leukoma, Dec 22, 2003
  5. jonesbr

    jonesbr Guest

    While I'm currently responding to Glenn's post, let me first thank
    everyone that has responded - I appreciate it! Further comments
    inline below...

    So I'm finding as I continue my search!

    I've read about occurances of both, but there doesn't seem to be a
    strong consensus regarding the cause(s). What has complicated the
    issue in my mind are discussions about how Stiles-Crawford effect
    negates the need for a correction zone greater than 6mm, provided that
    a sufficient blend zone is created. (In addition, the effect seems to
    vary depending on whether the obliquely oriented light is hitting rods
    or cones on the retina.) While the effect itself seems to have been
    originally articulated back in the 1930's, the recent discussions I
    have found almost treat it as a new discovery. (I've read some papers
    by Holladay, etc.)

    Yes, and I'm willing to wait rather than damage my night vision, but
    some idea of a timeline would be helpful. Most the new technology
    that I have seen discussed involves more complicated procedures, lens
    concepts or other such topics. I haven't seen much regarding advances
    in optical zone size and the resolution of night-vision problems in
    I'm still searching, but any pointers to such material would be

    jonesbr, Dec 22, 2003
  6. Glenn wants you to use a CRSQA surgeon and Dr. G is worried about
    liability. My interpretation of what they're saying is that wavefront
    LASIK as it is approved by the FDA currently would be EXTREMELY
    dangerous for you. LASIK in general is the most dangerous thing that
    most of people who have it do in their entire lives, but for you it is
    even MORE dangerous because it is NOT FDA approved for your pupil size

    LASIK also probably increases the risk of cancer, CJD and a number of
    other serious life threatening health problems. They'll (other
    posters here) try to discredit me, but they won't provide any evidence
    to the contrary. I can provide evidence.

    If you value your health, do NOT do LASIK or any other elective

    lasik advocate with flap melt, Dec 22, 2003
  7. jonesbr

    Dan Abel Guest

    If you want to have the least bit of credibility, you should stop making
    these kinds of comments. If I remember correctly, about 50,000 people die
    each year in car accidents. Now THAT'S dangerous. I don't know how many
    people die of LASIK each year, but I would guess none.
    Dan Abel, Dec 22, 2003
  8. Dr. Holladay is a respected member of our Board of Directors and he
    has been at the forefront of the prolate v. oblate cornea debate.

    The big issue is that there doesn't seem to be a strong consensus
    regarding the cause(s) because no one had been able to totally
    determine the cause(s). For that reason, the best that is offered is
    the safest route, and all else is an educated guess with the patient
    dealing with the consequences.

    I loath to predict the FDA, but history shows that optical size
    expansion and expansion of the treatable refractive error should be
    approved within two years. Some advances are available outside the US

    Glenn Hagele
    Executive Director
    Council for Refractive Surgery Quality Assurance
    glenn dot hagele at usaeyes dot org

    I am not a doctor.
    Glenn Hagele - Council for Refractive Surgery Qual, Dec 23, 2003
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