No link between large pupils, visual symptoms after wavefront-guided LASIK, study finds

Ophthalmology. 2011;118(4):736-741.

Large preoperative mesopic pupil size did not correlate with visual symptoms 12 months after wavefront-guided LASIK, a study found.

"Anecdotal reports suggest that wavefront-guided LASIK may generate fewer significant visual disturbances at night in patients with large pupil sizes compared with conventional LASIK. Subsequently, pupil size may have less relevance," the study authors said. "Future research addressing patients with unusually large pupils is warranted."

The prospective study included 102 eyes of 51 patients who underwent LASIK for mild to moderate myopia or astigmatism, with preoperative manifest spherical equivalent of -3.99 D.

Ablation was performed with the Visx Star S4 excimer laser with WaveScan (Abbott Medical Optics). LASIK flaps were created with the IntraLase FS femtosecond laser (AMO) or Hansatome microkeratome (Bausch + Lomb).

Pupils were classified as small (5.5 mm or less), medium (5.6 mm to 6.4 mm) or large (6.5 mm or more).

Patients underwent complete eye examinations and responded to a questionnaire on visual symptoms at baseline, 1 week, and 1, 3, 6 and 12 months after surgery.

Study results showed increased night glare scores in all groups at 1 month postop. However, between-group differences were insignificant. Glare scores diminished at all subsequent follow-up points.

A 12 months, medium pupils had significantly less glare at night than did small pupils (P = .02). Medium pupils had significantly fewer halos than did small pupils (P = .001) or large pupils (P = .02).

Patients with medium pupils reported significantly higher satisfaction in visual improvement than did those with small pupils (P = .014), the authors reported.