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    LASIK Problems Reduced With New Laser

    Larger Treatment Zone Lowers Risk of Problems in Patients With Large Pupils


    But in his study of 186 patients, many with larger-sized pupils fared better than those with the standard 6-millimeter surgical area. Overall, about 56% of patients with nearsightedness achieved vision of 20/20 or better, as did 62% of patients with nearsightedness and astigmatism. In the U.S., about 80% of patients achieve vision of at least 20/40 with LASIK.

    "The take-home message is that if you've been turned down as a LASIK candidate because of pupil size, you can have the procedure with a larger treatment zone. Or if you have haloes or glare as a result of having the procedure, they can be fixed," says Boxer Wachler. "Unfortunately, LADARVision is the only laser right now that can be used to do it, and since it's so advanced and very expensive, not many surgeons currently have it."

    Boxer Wachler uses a LADARVision laser in his Beverly Hills, California, clinic, but his study was not sponsored by its manufacturer and he reports no financial interest in the company. A list of other surgeons trained in using this laser is available at the LADARVision web site.

    "This is a good study and an important one, because a lot of surgeons ignore this -- they believe it doesn't matter what the pupil size is," says James J. Salz, MD, a spokesman for the American Academy of Ophthalmology who was not involved in Boxer Wachler's study.

    "If you treat a patient with a large pupil with a larger zone, it doesn't guarantee that they're not going to have nighttime complaints," he tells WebMD. "But we think it reduces the chance they will."

    Salz, clinical professor of ophthalmology at the University of Southern California Medical School, has this advice for anyone considering LASIK: "Be cognizant of what your pupil size is, and make sure your surgeon measures it -- not just estimates it -- in a dark room. If you have a pupil size greater than 6 millimeters, you are potentially at greater risk of nighttime halos, but that risk can be minimized if they have a larger treatment zone or if they have a customized treatment. I've seen too many patients with large pupils who hadn't and were unhappy with their results."

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