Topography of Lasik Cornea with Poor Night Vision

The topographic images below are that of a young man who underwent LASIK surgery several years ago. His vision in bright daylight is very good. However, his indoor and night vision is very poor. The colored topographies of this young man's eyes are not that interesting. Look at the size of his pupils. These images were taken in a low light environment. As you can see in these images, the diameter of his right pupil is 7.8 mm and his left pupil is 8.6 mm in diameter. A number of post-LASIK patients have written to me asking questions about LASIK and pupil size so I will attempt to make this controversy understandable. The diameter of a LASIK created treatment zone is 6.5 mm (more or less). In the earlier days of LASIK these treatment zones were much smaller. An pupil diameter is considered to be extremely large. Also bear in mind that the cornea sits about 4.5 mm in front of the pupil. Because of this fact, the diameter of the treatment zone will need to be considerably larger than the diameter of the pupil in order for this patient to see clearly indoors and at night. (Think of a person with a large head wearing and looking through eyeglasses meant for a small child). This young man, to see clearly at night (assuming there are no other LASIK induced complications), will need a treatment zone approaching 12 mm. which is impossible to do. This is why many LASIK surgeons give their young patients eye drops to constrict their pupils. We fit this young man with a large diameter scleral lens with a large viewing area (optic zone). However, even this was unable to address completely this patient's loss of quality vision at night. It is also important to understand that many of the LASIK created treatment zones are not directly over the pupil or the patient's line of vision (due to a number of reasons). With patients with these conditions the only viable non-invasive treatment is a scleral lens. With additional surgeries ("enhancements") patients run the risk of a number of unanticipated complications.

The Wavefront Scleral Lens

The corneal irregularities created by refractive surgeries, such as LASIK and RK, are responsible for ghosting, halos, starbursting, and loss of contrast sensitivity. These "higher order aberrations" may exist on both the anterior and posterior. With aberrometry, the defects of the entire optical system can now be corrected by a scleral lens.

The Wavefront Scleral Lens

Autologous Serum for Dry Eyes

Dry eye conditions are among the most challenging conditions faced by refractive surgery patients. With autologous serum, blood is spun down to plasma, forming an eye drop that helps rehabilitate the cornea.

Learn More about Autologous Serum

Dr. Boshnick on CBS This Morning

See Dr. Boshnick and Dr. Morris Waxler (former FDA chief research scientist on refractive surgery) talk about bad LASIK

Optimum Infinite Gas Permeable Material

I am happy to announce that our Global Vision Rehabilitation Center will be designing and fitting all of our “high need” patients with the Optimum Infinite gas permeable contact lens material. The Optimum Infinite material is the most oxygen permeable material ever to be approved by the FDA. In addition, this newly FDA approved material includes a UV lens blocker. Now for the first time, with certain patients, wearing a scleral lens made with the Infinite material under extended wear conditions can be considered.

SMAP 3D Scleral Lens Design

NEW: Powerpoint presentation on SMAP 3D

Last year we introduced an exciting piece of technology that has allowed us to custom design a scleral lens much more accurately. It is the SMAP 3D, which is a computer attached to a dedicated camera that allows us to obtain a 3 dimensional image of the entire front surface of the eye, including the cornea and the surrounding white portion of the eye (the sclera). Up until now there has not been any technology that would allow us to measure the ocular curvatures outside the cornea. The SMAP allows us to do this. Read More

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Blurred Vision, Burning Eyes: This Is a Lasik Success?

EyePrint Pro

EyePrintPro technology creates a scleral lens based on a mold of the cornea. The molding is accurate to 1 or 2 microns and fits perfectly because it exactly mirrors the irregularities of the individual corneal surface. The technology is well suited for post-Lasik, Keratoconus, RK, eye injury, and corneal transplant patients. Read More in this PDF about EyePrintPro Scleral Lens Technology

Watch Video at YouTube