Night Vision Problems
Dave Allamby | Jul 21, 2010 | Comments 11
Graeme just asked:
Hi Dave,
Two weeks ago I was treated with wavefront guided LASIK with Intralase by [clinic name deleted].
Although my vision was very good from the following day, I have had problems at night with severe starbursts, glare and halos around fluorescent lights (even indoors). I was told a couple of days ago that it will get better with time but since it’s hardly got better since day 1, I think there is a slim to no chance of this happening, especially as the eyes otherwise feel good with excellent vision.
Also, I was told a number of times that I had very large pupils which is why I needed wavefront guided LASIK to prevent my night visiion being affected. In hindsight and reading further on the Internet (which I now realise I should have done much more of) .
I guess I’m asking is there anything that I can do about this, anything I should ask them, e.g. pupil dilation, treatment area or anything like that to determine the reason for the starbursts and the fact that it hasn’t been done 100% correctly or I shouldn’t have been recommended as suitable? Or is there anything that can be done to improve it?
I wouldn’t obviously want further surgery but I’ve seen on this page info about more modern lasers and larger treatment areas that you have used which almost eliminate night vision problems. Could this be an option? Although I have paid out £3000 so far and so wouldn’t welcome another big outlay especially without guarantees of success. My main problem is that come the winter I won’t even be able to get to work if my night vision remains as bad as this.
I would be grateful for any suggestions or advice that you have.
Graeme, it is still very early after your treatment, so I think the advice from your clinic to wait is correct. I would normally allow 2-3 months for the vision to settle fully before looking if anything else needs doing, especially if it was a particularly large prescription. So please be patient for now.
Keep in contact with your clinic, and repeat testing at 4, 8 and 12 weeks post-op can help monitor your progress and relieve anxiety. You would want refractions and wavefront scans in particular, as night problems can arise from both low and high order aberrations. Low order means your prescription, but from your description your distance vision is excellent so not likely to be much prescription left – but you can confirm at your next visit.
It can occur if the treatment zone was significantly smaller than the scotopic (dark conditions) pupil size but clinics and doctors are well aware of this and modern lasers can treat a wide area of the cornea. You can ask about your dark pupil size and the full optical zone used at your treatment, as well as the total treatment zone (including the blend zone that feathers the treatment edges outside of the full optical zone area).
If the night vision problems persist, treatment is usually possible and will depend on the cause. Patience first though, as these symptoms can improve significantly yet. Give them the opportunity to assess and review your progress. Please let me know how you get on.
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I forgot to add my vision. It's -6.50 on both eyes. 
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Hi Dave,
I Type this with great concern, my night vision has not improved since i got the C TEN procdure done 4 months back. I still have ‘starbursts’ looking at all types of lights,esp when watching tv. My practitioner does not have a solution to why this is. i took vitamin c and omega-3 for 3 months as adviced. any type of assistance will be greatly appreciated.
hi Vishal, C-TEN is basically just PRK, another variant of surface laser treatment. There can be various reasons for starbursts, and they can be seen in the post-operative period. Typically they do improve with time so you might stick with your surgeon if things are getting better overall. However, if you see no improvement by 4 months, and if your surgeon cannot offer a solution or explanation, you might now wish to seek a second opinion. Thanks Dave
Hi
I have night vision problems after the procedure – light ‘leaking’ out from vehicle brake lights/traffic light signals etc – can this be corrected or is it permanent damage?
hi Clare
Thank you for your message. How long after your procedure? What was your prescription before? Do you know what it is now? Did you see any glare at night pre-op?
thanks, Dave
Just thought I’d chime in.. I have slightly larger than average pupils, and although I do get some star bursting in very very dark situations, it is nothing that I haven’t gotten used to. This only happens 5% of the time at night if I’m somewhere with absolutely no lighting.
I had halos for a while that were extremely extremely noticeable and looked like someone literally drew a circle around lights at night. Those thankfully completely disappeared within a couple of months. The biggest difference is that my night vision has become 1000% sharper and crisper, which I’m very thankful for.
Thanks Sharif. Agreed, as night vision problems for us are really a thing of the past. We of course, perform treatment diameters to cover the night pupil area, and advise patients that they may have some night vision effects during the first few weeks. But it is no longer something we think of as an issue we will be dealing with, with patients post-operatively.
Hi
I had Z-Lasik in the US about 2 weeks ago and since then had realised that there are numerous floaters in my treated eyes.
Would lasik result in floaters and will they ever go away?
Hi,
I have large pupils at night (7.9mm) and the lasik surger optical zone would be 6 and 6.3mm, would I have really bad night vision ? my prescription is -6 and -5.75 with -2.25 astigmatism in each eye (ps. I have no problem at all with night vision with contact lenses).
I also have thin corneas (480microns each) and in my last screening I was told my corneal topography is perfectly normal (one of their machines showed 0% )
Would it be safe for me to have lasik ? that is lasik with intralase laser.
Any advice would be much appreciated.
hi, We dont offer LASIK to patients with 480 corneas, only PRK. With 8mm pupils, I would want a 7mm optical zone, plus wider blend zone. I suspect you are not a good candidate for laser correction. regards David
I’m very close to signing up for treatment with you, but night vision remains one of my biggest concerns. I know I have a large dilated pupil size, so I presume this is taken into account. If your clinic felt any concern about the treatment area not being big enough, would this have been flagged in advance, or could I be border-line?
Thanks
hi Adam
We have not seen problematic night vision problems with Z-LASIK using the WaveLight excimer laser when treating short-sight, even for pupils up to 9mm. We enlarge the treatment zone to produce a wide ablation, of course. Typically your night vision will be the same as pre-op. As with any surgery there can be risks, so if you are not sure about LASIK then delay having treatment until you feel you are ready to proceed.
Regards, David