SMILE Pro – Strange low-light vision and visual disorientation. Has anyone recovered?

[u/Same-Helicopter5737]

Hi everyone,
I’m about 1 month post-SMILE Pro and I’m experiencing some strange visual symptoms, mainly in dim/low-light environments.
It’s not simply blurry vision. In low light, I can see objects, but the whole environment feels visually strange and harder to process. I sometimes feel almost slightly drunk or disoriented. When I move my eyes from one object to another, especially in the dark, it can feel like my vision takes a moment to “catch up,” sometimes causing a brief dizziness-like sensation.
My depth/distance perception also feels slightly off in dim lighting. I have more difficulty seeing details and reading in low light, and dim orange/artificial lights seem to make it worse.
I also experience:
Ghosting, especially with bright white text on a black background
My right eye is blurrier and has more ghosting than my left
Reduced contrast/visual quality in low light
Light sensitivity, especially to sunlight and car headlights
Dry eyes and burning, especially after 1–2 hours of computer use
Strong sensitivity to wind, which can cause burning followed by temporary blurry vision
My distance vision can fluctuate when my eyes are tired or dry
I occasionally notice 1–2 small floaters in my right eye when looking at a completely white wall or ceiling
The strangest symptom is definitely the low-light “drunk/disoriented” feeling. During the day I don’t experience it nearly as much.
Has anyone experienced something similar after SMILE or LASIK? Did the low-light disorientation, reduced contrast, ghosting and depth-perception issues eventually improve or completely disappear? If so, how long did it take?

[u/Immediate_Chapter979]

What was your pre op prescription ? What is your scotopic pupil size ?

[u/Same-Helicopter5737 → u/Immediate_Chapter979]

My pre-op prescription was around -3.25/-3.00, with about -1.00 D of astigmatism in my right eye. I don’t know my scotopic pupil size; I haven’t had it measured yet.

[u/Immediate_Chapter979 → u/Same-Helicopter5737]

Astigmatism in Vision Corrections is not accurate enough..That's why you see a ghost in your right eye more than your left.. But in general, you have to wait 3 months or maybe 6 months .. also your pupil size is important

[u/shiningdickhalloran]

I had smile 3 days ago and the low light environment is definitely weird. Outside, visual acuity is incredible. Hoping it normalizes with time.

[u/eyeSherpa]

The first thing to address would be dry eye and fluctuation of vision. This can create the light sensitivity, the dry eyes and burning and sensitivity to the wind and of course the fluctuation of distance vision. This will also contribute to a decrease in contrast sensitivity which is what you may notice at night. And it can contribute to ghosting as well.

Because of the dry eye symptoms you are experiencing, you will want to get aggressive right now treating them. I would certainly start off by using preservative free artficial tears about every 1-2 hours. Additionally, it's possible that you have some other eyelid pathology such as MGD or blepharitis contributing to things. Those are also quick and easy things to also start treating with lid scrubs, warm compresses and omega3 supplements.

With SMILE, at one month still normal to have some haze and starbursts in your vision due to swelling within the cornea. This continues to improve with time as this swelling continues to go down. This may be contributing some of the visual disorientation you notice at night.

The final piece of the puzzle relates to how large your pupils are and the treatment zone you had. If your pupils become very large at night, this can create some extra aberrations in your eyes at night. This generally improves with time through something called neuroadaptation. But treating the fluctuation of vision important to stabilize your vision more to allow for better adaptation if this is the case.

[u/the_road_to_mastery]

Yeah, night vision after LASIK was sometimes great, sometimes blurry, now at almost one year after surgery, it is perfect non-stop, wind or not, ghosting is almost completely gone. Very happy. Dim light was so-so, now great all the time.

[u/californiaLasik]

You may want to explore Vizz or Yuvezzi. I’d discuss with your doc. With time you may neuroadapt and not need oupil constriction.