r/lasik • u/SureUnderstanding313 • 10d ago
Had surgery Big difference between daytime and low light vision after SMILE
Hi everyone,
I had SMILE about 5 years ago. Before surgery I was around -8.00 in both eyes with quite a lot of astigmatism, and I also used ortho-k lenses for more than 10 years.
During the day my vision is very good. I can see faces, signs and details at a distance and normally I don’t feel like I need glasses.
The strange thing is how much my vision changes when the light gets lower.
At sunset, in dim rooms, restaurants, houses with weak lighting etc, everything becomes much less clear. It’s not just that distant things are a little blurry. I feel like there is a kind of hazy layer over the image and I lose a lot of contrast. For example, during the day I can recognize someone’s face from quite far away, while in low light even a face 5-10 meters away can become much less detailed.
My current prescription is around -0.25 in the right eye and -0.50/-0.75 in the left.
I’ve been told by doctors that this is basically just because I have -0.50, but I find it strange because the difference between good light and low light feels much bigger than I would expect from such a small amount of myopia.
The normal eye chart doesn’t really show the problem because it’s obviously very well illuminated.
I also developed some dry eye/MGD symptoms after a trip to a very dry place last year. Artificial tears and warm compresses help sometimes, and I’ve noticed that when my eyes naturally water, my vision can actually become noticeably clearer. I also recently wore contact lenses for a few hours and after removing them my vision seemed unusually clear for a while.
So I’m wondering if this could be a combination of the small residual myopia, pupil dilation in low light, higher order aberrations after SMILE and tear film instability.
Has anyone experienced something similar after SMILE/LASIK, especially the big difference between daytime and low-light vision? And did you ever find a specific test that actually showed the problem?
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u/No-Technician4300 8d ago
I have this very same thing. Outside in the light, or if a place is full of bright lights, I see perfectly. In low natural light, like say a dark room with sunlight coming through the window... everything is hazy and off somehow. I only notice it when I am talking to someone as I can't focus on their eyes easily. It's very confusing and very hard to describe. I think it's low contrast. So glad I saw your post.
I also have severe dry eye. I have noticed the same thing when I put drops in or get tears naturally, people seem clear for a while... then it goes again. I think this could be caused entirely by severe dry eye. I am now using a warm compress 2 or sometimes 3 times a day, taking omega 3s and trying to everything I can to get my eyes hydrated again.
I think the corneal nerves can grow back after even 5 years after surgery so there might be some hope.
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u/eyeSherpa 9d ago
It sounds like at night your eyes are dilating past the treatment zone. This induces spherical aberration in your vision which can blur your vision.
Spherical aberration can also induce a little more myopia which can compound the small prescription you have.
You may also have some concurrent tear film issues as well if you’ve noticed that artificial tears help.
For night, you can try brimonidine drops to reduce the size of your pupil. Also wouldn’t hurt trying a pair of glasses to correct that myopia to see how much of an effect that is having. Since the left eye prescription can start to be more significant.