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.
Furthermore, this prescription would deter most surgeons from performing an enhancement. In this case, night-time glasses would be the best solution.
In my clinic, pupil size does not have an impact on determining whether or not a patient is a good candidate. Patients who make poor candidates are those who want laser vision correction to eliminate glare they have with glasses or patients who indicate they never need to wear glasses, especially if they have current night vision challenges.
The ideal candidate
Another confusing topic within the optometry world is enhancement surgery. In the days of the microkeratome, surgeons would brag about how far out they could successfully lift a flap.
I remember being curious when a surgeon talked about lifting flaps that were seven years old and the procedure itself had been approved for only five years.
Over time what we learned was that not all flaps behaved the same when lifted and not all flaps were made equally. Surgeons would lift flaps that they, themselves, created but not those of other surgeons, and that practice became the norm. The greatest concern with this was epithelial ingrowth.
ODs would sometimes encounter that one patient, usually an older hyperope, who had recurrent ingrowth so problematic that amputation of the flap was the only feasible treatment option. This led to photorefractive keratectomy (PRK) becoming the preferred and most common method of enhancement because PRK eliminated the risk of ingrowth.
The pendulum has swung so far away from where it started, in fact, that some surgeons will not risk lifting a flap, even if it is less than three months old and they, themselves, created it.
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.