As laser vision correction improves and lasers become more precise, ODs are able to better identify great candidates for LASIK. And if, during that process, ODs remember old beliefs and conventional wisdoms regarding refractive surgery, it can allow for happy patients with even better vision outcomes.
Listening to Joe Rogan and Robert Downey, Jr. discuss laser vision correction in a recent episode of the “Joe Rogan Experience” podcast was both surreal and amusing.1 To paraphrase Rogan, “LASIK corrects vision, but it does not fix vision for things like we have, like macular degeneration.”
What they have is presbyopia, so he is correct to some degree. Unfortunately, I have had conversations with optometrists who are also confused about laser vision correction, mostly due to the evolution of knowledge surrounding laser in situ keratomileusis (LASIK). This article will cover a few common misconceptions.
A history of laser correction
About 15 to 20 years ago, every laser center was equipped with a Colvard pupilometer and measuring pupil size in scotopic conditions was necessary. Prior to wavefront-and topography-guided methods of treatment, night vision problems were a significant side effect and concern for those seeking surgery for myopia.
It was believed that scotopic pupil size was a significant contributor to night vision problems. A 2013 article published in the Journal of Refractive Surgery reviewed 19 papers that evaluated pupil size and night vision symptoms.2
In the conclusion, Dr. Schalhorn stated, “Modern LASIK has negated the role of the low light pupil in predicting adverse visual outcomes after LASIK outside of the early postoperative period.”
1. Joe Rogan Experience podcast #1411. Available at: http://podcasts.joerogan.net/podcasts/robertdowney-jr. Accessed 1/31/20.
2. Myung D, Schallhorn S, Manche EE. Pupil size and LASIK: a review. J Refract Surg. 2013 Nov;29(11):734-41.
3. Pop M, Payette Y. Risk factors for night vision complaints after LASIK for myopia. Ophthalmology. 2004 Jan;111(1):3-10.
4. C Chan, M Lawless, G Sutton, C Hodge. Re-treatment in LASIK: To Flap Lift or Perform Surface Ablation. J Refract Surg. 2020;36(1):6-11.
5. Friehmann A, Mimouni M, Nemet AY, Sela T, Munzer G, Kaiserman I. Risk Factors or Epithelial Ingrowth Following Microkeratome-Assisted LASIK. J Refract Surg. 2018 Feb 1;34(2):100-105.