A patient with a larger pupil size can experience increased higher-order aberrations; thus, an increase in the blur and glare symptoms observed by the patient. Large pupils paired with ocular surface irregularities can have an even greater influence on the overall quality of vision perceived by the patient.
To help minimize this glare, I recommend OTC Lumify (brimonidine tartrate ophthalmic solution 0.025%, Bausch + Lomb) for its secondary off-label effect of diluted brimonidine. Just like other selective alpha-2 agonists, Lumify reduces redness by constricting the conjunctival venules (instead of arterioles like tetrahydrozoline, Visine). The use of brimonidine has been shown in office to have a small, yet often symptomatically positive effect on pupil size in scotopic conditions, which seems to help decrease the glare and halo effects of night driving. 4
To most effectively maximize results and minimize enhancements rates, treating any hint of dryness before surgery helps “prime and prep” the cornea for the best visual and surgical outcome.
Dry eyes can significantly affect patients’ perception of their surgical outcomes and level of satisfaction; therefore, continuing to treat DED before and after refractive surgery sets up the patient for success.
Whether choosing artificial tears, punctal plugs, TearCare, LipiFlow, Xiidra, or Restasis to treat DED in post-refractive surgery patients, the root of the dryness should be established and discussed with the patient early in the process.
By making the patient aware of any dry eye and ocular surface problems—and taking the time to explain the realistic expectations of possible dry eyes in the future—it is easier for the patient to understand how to easily combat intermittent symptoms.
Assessing the overall eyelid and tear function, inferior corneal staining, and pupil size as factors that could be playing a role in overall quality of vision after surgery can help tailor a dry eye treatment regimen.
Prior to referring for LASIK/PRK or a refractive enhancement, it is ideal to identify and aggressively treat underlying dry eye and OSD.
1. Cohen E, Spierer O. Dry Eye Post-Laser-Assisted In Situ Keratomileusis: Major Review and Latest Updates. J Ophthalmol. 2018 Jan 28;2018:4903831.
2. Yu EY, Leung A, Rao S, Lam DS. Effect of laser in situ keratomileusis on tear stability. Ophthalmology. 2000 Dec;107(12):2131-5.
3. Solomon R, Donnenfeld ED, Perry HD. The effects of LASIK on the ocular surface. Ocul Surf. 2004 Jan;2(1):34-44.
4. Edwards JD, Burka JM, Bower KS. Effect of brimonidine tartrate 0.15% on night-vision difficulty and contrast testing after refractive surgery. 2008 Sep;34(9):1538-41.