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.
The majority of studies found no correlation between the low light pupil’s role in predicting visual outcomes after LASIK. Those that found a slight correlation were either evaluating night vision in the early post-operative period or were using optic zones of less than 6 mm.3
Night vision after LASIK
So, what should patients be told about night vision symptoms after laser vision correction?
I suggest ODs first ask their patients about night vision problems with their current method of correction. I have found that patients who experience night vision symptoms with their glasses and/ or contact lenses will likely experience the same symptoms after laser vision correction.
Additionally, as the tear layer is getting back to normal, patients will experience night vision symptoms more often than not.
The easiest way to glean that diagnosis from a patient is to ask about vision right after the instillation of an artificial tear. If it clears up, even just for a few seconds or so, the culprit is the tear layer. If it does not clear, then uncorrected refractive error is the more likely culprit.
While a refraction of +0.25-0.50 x 175 does not impact daytime vision for some patients, it can have a significant effect on the quality of night vision, despite uncorrected visual acuity (UCVA) of 20/20.
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.