Clear definitions, measurement tools needed for pupil size, glare

NEW YORK — The measurement and documentation of glare and pupil size in refractive surgery may raise legal concerns for surgeons, said Louis E. Probst, MD, here at the Ocular Surgery News Symposium on Cataract, Glaucoma and Refractive Surgery.

“This is a controversial area. The more I investigate this issue, the more I realize that there is very little we understand,” Dr. Probst said. The potential for legal action against the surgeon as a result of poor documentation of glare and pupil size is a grave concern, he said.

“The first problem is that measuring pupils is critical, in that optical zone and blend zone is programmed based upon pupil size,” Dr. Probst said. Surgeons must determine the correct optical zone and blend zone given a particular pupil size, and the variety of available devices give different results, he said.

In addition, he said, clinicians must pay closer attention to the terminology they’re using.

“The terms glare, glare disability and contrast sensitivity have been used very loosely, meaning different things often not well-defined by various authors,” Dr. Probst said.

Other issues include the lack of a gold standard of testing for glare, the lack of an objective test for glare, and the lack of evidence in the literature confirming a relationship between pupil size and glare.

Dr. Probst concluded that malpractice claims based upon pupil measurements are a risk; terms and standard tests must be defined; and there is a clear need for studies to define the relationships among glare disability, pupil size, aberrations and wavefront measurements.