Visian ICL Halos & Glares
One of the most common side effects from having the Visian ICL procedure is glares that surround lights at night and various halo effects. Sometimes, these effects are barely noticeable – or you could be like me and have them for around 9 months, after the Visian ICL surgery.
These halo effects are commonly referred to as starburst halos. But, they could show up looking a number of different ways. I don’t want to scare you off from the Visian ICL procedure, newly upgraded lens models greatly diminish these risks of halos and glares. It’s just something to be aware of before going into such a life altering surgery.
If you do end up with these dreaded side effects, don’t worry! There are ways to get rid of them, without having your brand new high-definition lenses removed.
Time Heals All Wounds
Almost everyone who goes through with the Visian ICL procedure will suffer halos and glares at least for a week or two after the surgery. This is just a given, your eyes are swollen and still healing from the procedure. If you are having concerns, you can ask your surgeon about it at your next follow-up visit – but my guess is, they are just going to tell you your eyes need time to heal and the halos or glares should go away in the next couple weeks.
You should start being a little concerned when you’re still seeing halos and glares months after your surgery. Maybe, by this time they have lessened? If so, you might want to give them a little more time – don’t jump the gun and start freaking out.
If they’re still not going away, you may want to discuss prescription eye drops with your surgeon.
Constriction Eye Drops
There are a number of different eye drops that can be prescribed to help constrict your pupils. There’s also a lot of evidence pointing to the size of your dilated pupil as being a typical cause of halos and glares in Visian ICL patients. I’ll get into that later within this post.
I eventually had to go this prescription eye drop route. I tried to wait it out as long as possible, but after about 6-7 months I gave in and had Alphagan P prescribed to me.
My only concern with these eye drops was about dependency. I’ve always heard horror stories of creating this dependency where your eyes have to have it daily just to function properly.
It even happened to me many years ago with a visine type of over-the-counter drop. It got really bad there for awhile, my eyes would get beet red and the only relief would come from the drops – but that relief time would get shorter and shorter.
Eventually I had to quit cold turkey and power through the red, itchiness. I don’t recommend falling victim to that dependency.
So, I took it easy with the Alphagan P. This drop really helped me. I would only put a drop in, if I had to drive at night. I only used it a few times over the next couple months in combination with the Refresh Tears drops above, and eventually my halos & glares cleared up completely. **If you are going to use the Refresh Tears drops, I highly recommend storing them in the refrigerator so you have a refreshing, cool effect when they drop into your eyes.**
Pupil Size Evidence
Obviously, the main reason for my 9 months of halos and glares was that my pupils dilated too big when in low light or night areas. I had more of a problem with my right eye, the left had cleared up much sooner. So, this is something you will want to discuss with your surgeon during the Visian ICL consultation.
During the consultation they will take all the necessary measurements and it appears that 5-6mm is the size of pupil dilation you’re looking for. Again, I’m not a doctor so make sure to discuss this at length with your consultation doctor. I am currently awaiting a copy of my full medical records during the whole Visian ICL process – I will relay the exact size measurements of my own pupils to give you a better reference.
Natural Eye Care
If you like more natural, at home remedies – there are a lot of nutritional supplements that help promote overall eye and vision health. I currently take iCaps and Bilberry supplements purchased from Amazon.
Bilberry could help to remove halos and glares in low light situations because it improves night vision and light adaptation. It also supports healthy blood flow to deliver nutrients to eye muscles and nerves.
iCaps contain lutein & zeaxanthin, both of which have been proven to help improve overall eyesight.
This Better Vision website also contains a lot of useful information & products that can help you to improve your night vision and get rid of those crazy halos or glares.
I hope the thought of halos and glares as a side effect has not deterred you from the Visian ICL procedure. Just make sure you see what your pupil dilation measurements are during the consultation and discuss everything with your surgeon. Then, once you have the procedure if you do experience the halos and glares – you still have options.
Time, constriction eye drops and some eye health nutrition supplements is what ultimately worked for me. I think if you have a higher degree of myopia going into the surgery, you could experience more severe halos and glares.
This was probably the case with me since my degree of myopia was nearly -13. My lenses have a prescription level of -13.5 left eye and -14 right eye! Not too many have this high of a prescription level.
I assume most of you contemplating and/or going through with the Visian ICL procedure will NOT have the same severity of halos and glares that I had.
Thanks for reading and if you have any questions or comments please drop them in the comment section below.
I’m going to provide some reference material about pupil sizes and how it can be a determining factor on what type of side effects one may encounter after laser eye surgery.
Pupil Reference Information
Intraocular light scatter increases with increased pupil size, a fact known since before the days of radial keratotomy(1). After pharmacologic dilation (even in virgin eyes), higher order aberrations routinely increase. A larger pupil will increase the level of spherical aberration for any given corneal asphericity(2). A large pupil under low mesopic conditions may result in a halo around lights even in patients that have never had any form of refractive surgery.
In the earliest forms of excimer keratorefractive surgery, optical zones were routinely smaller than what is commonly used today (approximately 4mm versus 6mm). Similarly, blending algorithms to apply pulses outside the optical zone were not well-developed. Therefore, high levels of spherical aberration could be induced with earlier excimer platforms. Unwanted visual phenomena correlate best with greater ablation depth, younger age, and smaller optical zones. While larger pupils may not correlate with night vision symptoms, it has been suggested that LASIK satisfaction is higher in those without large pupils(3).
Ironically, a small pupil can limit vision as well. Light diffraction is a concern for patients taking miotics, the elderly, and in certain diseases (e.g. myotonic dystrophy) due to a small pupil diameter. Small pupils can limit the efficacy of multifocal refractive options as well as night vision in virgin eyes. This is balanced by a possible increase in depth of focus for patients with smaller pupils.
Prior to any vision correction surgery, pupil measurement is recommended. Challenges to obtaining a true pupil size under low light include: the accommodative reflex (perhaps enhanced by awareness that one’s pupils are being measured), lack of adequate time for dark adaptation, unreliable technology, and poor technique(4). Moreover, the low-light pupil size of a healthy individual can vary greatly due to factors such as level of alertness, recent medications, and emotional state.
Ideally, the pupils are measured in the non-accommodated state, best simulated by providing a distant target for fixation. Some devices provide no real target and need verbal instruction to “focus in the distance.” Some devices rely on a light emitting diode (LED) inside the apparatus for fixation. Still other devices use infrared technology to capture pupil size.
While many of the technologies mentioned herein provide a fair estimation of pupil size, it is not as easy to get a true size as the layperson would expect due to device, examiner, environment, and patient limitations. Additionally, hippus, a physiologic variation of the pupil size with rhythmic constriction and dilation, can make measurement challenging.
Thus, any pupil measurement (usually stated in millimeters) in a refractive workup may or may not be a true representation of average pupil size during a patient’s daily life.
Most studies have found that the average dim light pupil size for refractive surgery candidates is around 6mm. Those with pupils larger than 6mm are not necessarily considered abnormal, because pupil size is a dynamic entity with a well-known lifelong size decrease. Therefore, a twenty-one year old patient with “big pupils” may have normal pupil size in her forties.
Posterior chamber phakic intraocular lenses require a pharmacologically large pupil for atraumatic insertion. A larger natural dim pupil size, therefore, may be a surgical advantage for this type of refractive option.
Some unwanted visual symptoms (e.g. halo) are to be expected , however, in patients with low-light pupils that enlarge beyond the diameter of the optic (6mm or less, depending on power). Kamiya et al. found in a study of the Visian ICL that average preoperative pupil size did not change significantly post implantation(5).
Assessment of pupil size has become a routine component of a thorough refractive workup. Improvements in technology have made both pupil measurement and quality of vision after refractive procedures superior than in years past. While a frank discussion between the surgeon and patient is critical, it is now clear that larger low-light pupils do not preclude refractive surgery.
1. Veraart HG, van den Berg TJ, IJspeert JK, Cardozo OL. Stray light in radial keratotomy and the influence of pupil size and straylight angle. Am J Ophthalmol. 1992;114:424-8.
2. Calossi A. Corneal asphericity and spherical aberration. J Refract Surg. 2007;23:505-14.
3. Hammond SD Jr, Puri AK, Ambati BK. Quality of vision and patient satisfaction after LASIK. Curr Opin Ophthalmol. 2004;15:328-32.
4. Ho LY, Harvey TM, Scherer J, Balasubramaniam M, Dhaliwal DK, Mah FS. Comparison of Rosenbaum Pupillometry Card Using Red and Blue Light to Colvard and Iowa Pupillometers. J Refract Surg. 2009;Sep 2:1-7.
5. Kamiya K, Shimizu K, Igarashi A, Ishikawa H. Evaluation of pupil diameter after posterior chamber phakic intraocular lens implantation. Eye. 2010;24:588-94.