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21.4% of patients who did not have floaters get them from LASIK
|
|
| LASIKtruth 2005-05-07, 10:52 pm |
| http://www.ophsource.org/periodical...01913X/abstract
Effect of Microkeratome Suction During LASIK on Ocular Structures
Presented at: American Academy of Ophthalmology Annual Meeting, November,
2003; Anaheim, California.
Alireza Mirshahi, , Thomas Kohnen, ?
Received 5 May 2004; accepted 7 November 2004 published online 18 February
2005.
Purpose
To study the effect of microkeratome suction on ocular structures during
LASIK.
Design
Observational, prospective case series.
Participants
Twenty-one eyes of 11 patients with myopia or astigmatic myopia (8 females,
3 males) were included. The mean patient age was 36.3 years (median, 37
years; range, 24-48 years), and the mean spherical equivalent was ?5.03
diopters (D) (median, ?4.63 D; range, ?2.38 to ?8.38 D).
Methods
We performed preoperative and intraoperative A-scan ultrasonography during
application of suction using the Hansatome microkeratome (Bausch & Lomb
Surgical, Munich, Germany) to create corneal flaps during LASIK. We also
performed preoperative and postoperative B-scan ultrasonography of the
posterior ocular segment with special attention to the presence and size of
posterior vitreous detachment (PVD).
Main Outcome Measures
We measured changes in the axial length, anterior chamber depth, lens
thickness, and vitreous distance (distance from the posterior lens capsule
to the posterior pole) during application of the microkeratome suction ring
and recorded new occurrences of or increases in the size of the PVD after
surgery.
Results
The lens thickness decreased (mean change, ?0.20 mm; P = 0.001; 95%
confidence interval [CI], ?0.11 to ?0.30) in 18 eyes during application of
the suction ring. The vitreous distance increased (mean change, 0.20 mm; P =
0.004; 95% CI, 0.08-0.32) in 16 eyes. No statistically significant changes
were found in the anterior chamber depth (P = 0.75) or axial length (P =
0.51). After surgery, 3 of 14 eyes (21.4%) experienced PVD that did not have
echographic signs of PVD before surgery. Of 7 eyes with preoperative PVD,
the PVD enlarged in 1 eye (14.3%).
Conclusions
During application of microkeratome suction, the lens thickness decreases,
whereas the vitreous distance increases, suggesting anterior traction on the
posterior segment. The relationship between the observed PVD and LASIK
merits further investigation.
| |
| serebel 2005-05-07, 10:52 pm |
| Since when is lasik the only application for the suction ring?
SErebel
| |
| Glenn - USAEyes.org 2005-05-08, 8:57 am |
| The suction ring is used to fixate the eye with all microkeratomes.
This includes the traditional mechanical microkeratome, the
femtosecond laser microkeratome, and the epithelium microkeratome,
commonly called the epikeratome.
The duration of application of the suction is not long, but during
that time the intraocular pressure (IOP) is significantly raised. As
affirmed in the cited report, the temporary elevation of IOP normally
does not cause significant problems, but the possibility exists. This
includes floaters.
Floaters are small particles of the inner eye that float around in the
clear liquids and gels within the eye. They are common among all
people but can be created by LASIK, IntraLASIK, EpiLASIK. Also,
existing floaters can be disturbed by these and almost any other eye
surgery or eye trauma.
There is no cure for floaters, however the brain seems to become
accustomed to them and will ignore minor floaters.
People who are severely myopic have a higher risk of retinal problems
because the eye is elongated and the retina is often stretched over
this larger than normal eye ball. For this reason, people with
extreme myopia tend to be predisposed to floaters.
Anyone considering refractive surgery who has a history of floaters or
problems with vitreous or retina should be evaluated by a retina
specialist before having a refractive surgery procedure that uses a
microkeratome.
Although there is always the possibility of problems, PRK and LASEK do
not require the high inner eye pressure of LASIK, IntraLASIK, and
EpiLASIK, therefore the probability of problems with floaters is
less. These techniques may be appropriate alternatives, or it may be
that no surgery is appropriate.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| FloaterLasik 2005-05-18, 11:45 am |
| Hi Glenn,
I have spoken to doctors and they say that the Microkeratome will not be an
issue with my floaters. I have always known that many lasik have stated that
this was induced after their lasik procedure. I suggested the surface
ablation and they stated they do not like using mitomycin-c because they are
concerned about corneal meltdown.
Do you know anything about this corneal meltdown concern when using
mitomycin-c after a surface ablation to reduce haze?
Thanks!
"Glenn - USAEyes.org" <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message
news:ae7r71tb3ck7nap2oftaqa1rfn4lmejiie@4ax.com...
> The suction ring is used to fixate the eye with all microkeratomes.
> This includes the traditional mechanical microkeratome, the
> femtosecond laser microkeratome, and the epithelium microkeratome,
> commonly called the epikeratome.
>
> The duration of application of the suction is not long, but during
> that time the intraocular pressure (IOP) is significantly raised. As
> affirmed in the cited report, the temporary elevation of IOP normally
> does not cause significant problems, but the possibility exists. This
> includes floaters.
>
> Floaters are small particles of the inner eye that float around in the
> clear liquids and gels within the eye. They are common among all
> people but can be created by LASIK, IntraLASIK, EpiLASIK. Also,
> existing floaters can be disturbed by these and almost any other eye
> surgery or eye trauma.
>
> There is no cure for floaters, however the brain seems to become
> accustomed to them and will ignore minor floaters.
>
> People who are severely myopic have a higher risk of retinal problems
> because the eye is elongated and the retina is often stretched over
> this larger than normal eye ball. For this reason, people with
> extreme myopia tend to be predisposed to floaters.
>
> Anyone considering refractive surgery who has a history of floaters or
> problems with vitreous or retina should be evaluated by a retina
> specialist before having a refractive surgery procedure that uses a
> microkeratome.
>
> Although there is always the possibility of problems, PRK and LASEK do
> not require the high inner eye pressure of LASIK, IntraLASIK, and
> EpiLASIK, therefore the probability of problems with floaters is
> less. These techniques may be appropriate alternatives, or it may be
> that no surgery is appropriate.
>
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.
| |
| Glenn - USAEyes.org 2005-05-18, 11:45 am |
| If you require more than about 6.00 diopters of correction, LASIK is
normally going to be the front runner of the different procedures.
The reason is that the stromal flap "fools" the eye into not realizing
that it has had surgery. This limits the healing response and limits
the probability of corneal haze that tends to occur with high
refractive error and surface ablation techniques like PRK, LASEK, and
Epi-LASIK.
Mitomycin C is a topical medicine that attempts to pharmaceutically do
the same thing the LASIK stromal flap does: change the wound healing
response. IMO Mitomycin C is strong medicine that is best avoided if
possible, but appropriate when necessary.
I do not agree that LASIK and floaters have nothing to do with each
other, but if the choice is corneal haze or floaters, you would
probably want to choose the floaters hands down...
....or choose not to have surgery.
We have an article on LASIK at
http://www.usaeyes.org/faq/subjects/lasik.htm that goes into some of
the detail of wound response, advantages/disadvantages of surface
ablation, etc.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| ycdbsoya 2005-05-18, 11:45 am |
| I never had floaters before LASIK. I was -5.5/-5.25. Got $hitloads of
them now, and they do interfere with my vision. I'm one of the unlucky
ones who cannot "tune out" these little annoying protien strands.
| |
| CatmanX 2005-05-18, 11:45 am |
| Something to remember here is that you will get them sooner or later
anyway. If it can be induced by the keratome, it will happen in time as
the vitreous becomes more liquid.
dr grant
| |
| Informer 2005-05-18, 11:45 am |
| Why get really bad floaters sooner? We're all going to die, too - wouldn't
you want to forestall that inevitability? Most of us may lose our teeth.
Isn't it worthwhile to do the things that will keep a healthy set of teeth
longer? Floaters can be horrendous after LASIK. I have a friend with a huge
curtain floater she acquired after her LASIK surgery and it has a profound
negative impact on the quality of her life.
"CatmanX" <grantm@connexus.net.au> wrote in message
news:1115761631.379223.213630@f14g2000cwb.googlegroups.com...
> Something to remember here is that you will get them sooner or later
> anyway. If it can be induced by the keratome, it will happen in time as
> the vitreous becomes more liquid.
>
> dr grant
>
| |
| serebel 2005-05-18, 11:45 am |
|
Informer wrote:
> Why get really bad floaters sooner? We're all going to die, too -
wouldn't
> you want to forestall that inevitability? Most of us may lose our
teeth.
> Isn't it worthwhile to do the things that will keep a healthy set of
teeth
> longer? Floaters can be horrendous after LASIK. I have a friend with
a huge
> curtain floater she acquired after her LASIK surgery and it has a
profound
> negative impact on the quality of her life.
>
I have friends who don't have any floaters after lasik. It's an
individual choice to have RS.
SErebel
| |
| Ragnar 2005-05-18, 11:45 am |
| First, that 21.4% figure is compete nonsense. Forget it.
I would love to hear your theory on how LASIK is the cause of
floaters.
I have one theory for floaters, starbursts, etc. They were there all
the time. Before lasik, you didn't see the strands floating around -
they were just a blur. Before lasik, streetlights look like a glowing
ball of cotton. After lasik, you see all the defects manifest in the
BACK of your eye and in the vitreous fluid between your cornea, lens
and the back of your eye.
Actually, I was so nearsighted before LASIK that I used to see
floaters all the time. I could focus in on them. After LASIK I see
no floaters at all. I'm sure there is still some microscopic strands
there, but I'm not seeing them. My focus is now on distant objects
and not on things an inch in front of me.
On Wed, 11 May 2005 21:17:56 -0400, "Informer"
<Informer@Yahoo_nospam.com> wrote:
>Why get really bad floaters sooner? We're all going to die, too - wouldn't
>you want to forestall that inevitability? Most of us may lose our teeth.
>Isn't it worthwhile to do the things that will keep a healthy set of teeth
>longer? Floaters can be horrendous after LASIK. I have a friend with a huge
>curtain floater she acquired after her LASIK surgery and it has a profound
>negative impact on the quality of her life.
>
>"CatmanX" <grantm@connexus.net.au> wrote in message
>news:1115761631.379223.213630@f14g2000cwb.googlegroups.com...
>
| |
|
|
|
|
"Ragnar" <ragnarsuomi@yahoo.com> wrote in message
news:6op581tbe344b40ktl6oiiqngt0vqulabe@4ax.com...
> First, that 21.4% figure is compete nonsense. Forget it.
>
> I would love to hear your theory on how LASIK is the cause of
> floaters.
> I have one theory for floaters, starbursts, etc. They were there all
> the time. Before lasik, you didn't see the strands floating around -
> they were just a blur. Before lasik, streetlights look like a glowing
> ball of cotton. After lasik, you see all the defects manifest in the
Rags your theory - "they were there all the time" may well apply to floaters
but definetly doesn't apply with starbursts and or halo's in my case and
probably others who suffer from them.
I agree with your next statement that before lasik street lights were fuzzy,
a bit like seeing halos BUT only when not wearing glasses/contacts. I mean I
wouldn't ever have even attempted to drive before without glasses. Now even
with halo's I feel safe enough on the road at nights but defenatly felt
safer before wearing glasses and having no halo's
I am still all for Lasik and think its a miracle procedure but I think we do
need to realize that although its great, there are sometimes some negitive
side effects.
Personally I can't see how floaters could develope as a side effect. I am a
little like you in that when I was young I saw floaters regurly. I can't
remember when I saw my last one since lasik but am sure that having had
lasik isn't the reason I don't get floaters any more and vise versa for
people who now get them.
Wal
| |
| lindakendall3155@gmail.com 2005-05-18, 11:46 am |
| Dear Wal,
I think it's great that you have the courage to speak out about your
starbursts and halos, especially since you were so pro-lasik to start
with. The more I read here, the luckier I feel. I had night vision
problems, but only because I was undercorrected. After my 2nd op, this
was resolved. I did have fluctuations in the quality of my vision for
over a year, but my eyes are very stable now. One of your comments is
true for me also. I definitely had crisper vision with contacts and
glasses, particularly at night, but contacts and glasses are designed
to give you "perfect" vision whereas I believe the aim of Lasik is to
give normal vision. Does your doctor feel that your complications will
eventually subside or will you be stuck with halos and starbursts?
Regards,
Linda
| |
| Tabby 2005-05-18, 11:46 am |
| Having reduced contrast sensitivity and induced higher order aberrations is
not 'normal vision'.
<lindakendall3155@gmail.com> wrote in message
news:1116032904.832264.164170@f14g2000cwb.googlegroups.com...
> Dear Wal,
> I think it's great that you have the courage to speak out about your
> starbursts and halos, especially since you were so pro-lasik to start
> with. The more I read here, the luckier I feel. I had night vision
> problems, but only because I was undercorrected. After my 2nd op, this
> was resolved. I did have fluctuations in the quality of my vision for
> over a year, but my eyes are very stable now. One of your comments is
> true for me also. I definitely had crisper vision with contacts and
> glasses, particularly at night, but contacts and glasses are designed
> to give you "perfect" vision whereas I believe the aim of Lasik is to
> give normal vision. Does your doctor feel that your complications will
> eventually subside or will you be stuck with halos and starbursts?
> Regards,
> Linda
>
| |
| lindakendall3155@gmail.com 2005-05-18, 11:46 am |
| Yes, but this is not the case for most Lasik recipients. Abnormal
vision is not being able to see your hand in front of your face
clearly. This was the case for me prior to Lasik. Do not underestimate
the distress caused by failing eyesight. I am so glad I live in an era
when there are options available for people like me to correct failing
vision.
Linda
| |
|
| Hi Linda,
<lindakendall3155@gmail.com> wrote in message
news:1116032904.832264.164170@f14g2000cwb.googlegroups.com...
> Dear Wal,
> I think it's great that you have the courage to speak out about your
> starbursts and halos, especially since you were so pro-lasik to start
> with.
Well I guess at the start the halo's seemed like a minor side effect as I
was on such a huge high.
I still am by the way. I am extremely happy I had it done.
At the start I was sort of hoping that the halo's would go away.
Unfortunatly they are no different now than they were after the first month.
I am a little annoyed with my Doctor over her lack of responce when I
mention the halo's. She gives me the impression that she thinks because I
have such fantastic vision on the eye chart - 20/10 in both eyes then I am
being a winger by mentioning them. Its a bit like others here have said that
the eye chart means everything to the docs. If you can read 20/20 or better
than its been a huge success. Other problems don't seem to count.
I am also wondering if my pupil size has been measured correctly. At the
start they mesured them at 6mm dialated. If this is correct then I shouldn't
be seeing halo's should I ?
The more I read here, the luckier I feel. I had night vision
> problems, but only because I was undercorrected. After my 2nd op, this
> was resolved. I did have fluctuations in the quality of my vision for
> over a year, but my eyes are very stable now.
Yes I agree you should be very happy with your results.
One of your comments is
> true for me also. I definitely had crisper vision with contacts and
> glasses, particularly at night, but contacts and glasses are designed
> to give you "perfect" vision whereas I believe the aim of Lasik is to
> give normal vision. Does your doctor feel that your complications will
> eventually subside or will you be stuck with halos and starbursts?
In the day time I see probably better now than with glasses. Its just night
time.
Ok see ya Linda
Regards
Wal
| |
| Glenn - USAEyes.org 2005-05-18, 11:46 am |
| Wal,
Excuse me for not recalling all of the details of your surgery. I'm
sure we have covered some of this ground before, but others reading of
your situation may find some of the info helpful too.
Halos can occur even if you have normal pupils, but it is more common
that pupil size in relation to the optical ablation zone is the
culprit. For details on this issue visit
http://www.usaeyes.org/faq/subjects..._pupil_size.htm
You pupils may be 6.0mm, but if the optical ablation is 5.5mm then you
have the potential for trouble.
What is probably more important than just the size of your pupils or
the size of the optical ablation zone is the amount of correction that
was required.
Flattening the center of the cornea for myopic correction dramatically
changes the optics of the eye in ways that probably are still not
fully understood. A large amount of flattening may induce halos.
It may be valuable for you to have a wavefront analysis to see which
higher order aberrations are elevated. Of course, this needs to be
administered with your pupils dilated as they are at night when you
are driving. My bet is that your spherical aberration, coma, and/or
secondary astigmatism are unusually elevated.
Depending upon the cause of your halos, it may be possible to resolve
them with Complex Wavefront Retreatment (CWR), but CWR is surgery and
you would need to weight the potential benefit against the potential
risk.
Before you start considering additional surgery, there are a few other
things you can consider. You may simply be under or overcorrected
slightly. Although you can see the 20/10 line in bright light, the
centermost portion of the cornea almost always provides better vision.
If your examination was with lowered light and/or with your pupils
dilated, it may be that there is enough myopia or even hyperopia to
cause the starbursting from blur.
If there is any residual refractive error, the obvious first step
would be glasses or contacts. I would not be at all surprised if a
proper fitting of contacts resolves the problem. That is much less
invasive than more surgery.
Alphagan P works very well at reducing the size of the pupil without
causing a lot of disruption. These eye drops used when needed may be
a helpful workaround.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| Debbie 2005-05-18, 11:46 am |
| I think it is hideous that so many LASIK patients report that their vision
is not as crisp after LASIK, yet doctors do not warn patients up front that
their visual quality after LASIK may be lower than with glasses. Since this
is the visual quality you will have for the rest of your life, this seems
like an important tidbit of information, no?
By the way, my vision is not merely less crisp, it is total garbage.
"Wal" <notmewally@hotmail.com.au> wrote in message
news:d67ei7$oa7$1@domitilla.aioe.org...
> Hi Linda,
>
> <lindakendall3155@gmail.com> wrote in message
> news:1116032904.832264.164170@f14g2000cwb.googlegroups.com...
>
> Well I guess at the start the halo's seemed like a minor side effect as I
> was on such a huge high.
> I still am by the way. I am extremely happy I had it done.
> At the start I was sort of hoping that the halo's would go away.
> Unfortunatly they are no different now than they were after the first
> month.
>
> I am a little annoyed with my Doctor over her lack of responce when I
> mention the halo's. She gives me the impression that she thinks because I
> have such fantastic vision on the eye chart - 20/10 in both eyes then I am
> being a winger by mentioning them. Its a bit like others here have said
> that
> the eye chart means everything to the docs. If you can read 20/20 or
> better
> than its been a huge success. Other problems don't seem to count.
> I am also wondering if my pupil size has been measured correctly. At the
> start they mesured them at 6mm dialated. If this is correct then I
> shouldn't
> be seeing halo's should I ?
>
>
>
> The more I read here, the luckier I feel. I had night vision
>
> Yes I agree you should be very happy with your results.
>
>
> One of your comments is
>
> In the day time I see probably better now than with glasses. Its just
> night
> time.
>
> Ok see ya Linda
> Regards
> Wal
>
>
>
| |
| serebel 2005-05-18, 11:46 am |
| Just because you say your vision is garbage doesn't make it so for
everyone else there Debbie.
SErebel
| |
| Pauli Soininen 2005-05-18, 11:46 am |
| > I am also wondering if my pupil size has been measured correctly.
> At the start they mesured them at 6mm dialated. If this is correct
> then I shouldn't be seeing halo's should I ?
My suggestion would be for you to get your dialated pupil size measured with
definite accuracy. Or you can do it yourself if you have the means to do so.
If you find out your accurate pupil size, I'd be interested to hear it (add
also your perfect optical zone + transition zone sizes).
Or you can use a good quality video camera with infrared function filming
your eye, look at lights at dark and use a flashlight to constrict and
dilate your pupil. If you can see halos reducing to zero at some point, you
can then measure the pupil size for that moment from the video if it's
accurate enough (you can mark the moment by waving your finger or
something).
| |
| Ragnar 2005-05-18, 11:46 am |
| measuring your own pupil size is going to be entirely inaccurate.
On Mon, 16 May 2005 07:02:13 GMT, "Pauli Soininen" <no@spam.com>
wrote:
>
>My suggestion would be for you to get your dialated pupil size measured with
>definite accuracy. Or you can do it yourself if you have the means to do so.
>If you find out your accurate pupil size, I'd be interested to hear it (add
>also your perfect optical zone + transition zone sizes).
>
>Or you can use a good quality video camera with infrared function filming
>your eye, look at lights at dark and use a flashlight to constrict and
>dilate your pupil. If you can see halos reducing to zero at some point, you
>can then measure the pupil size for that moment from the video if it's
>accurate enough (you can mark the moment by waving your finger or
>something).
>
| |
| Pauli Soininen 2005-05-18, 11:46 am |
| > measuring your own pupil size is going to be entirely inaccurate.
I managed to do it within 0.2mm accuracy compared to the doctor's
measurement. But you're right - it's not going to be that easy to do it
accurately by yourself (or with friend's help).
It's best to do it with multiple methods and many times if you want some
accuracy with do-it-yourself methods. High resolution infrared camera,
accurate ruler very close to eye are good to have (and a stable hand plus a
sharp eye and/or good image editing skills).
And notice that the pupil and the iris have slightly greater width than
height.
| |
|
| Hi Glen,
> You pupils may be 6.0mm, but if the optical ablation is 5.5mm then you
> have the potential for trouble.
I have no idea what ablation size I had.
> What is probably more important than just the size of your pupils or
> the size of the optical ablation zone is the amount of correction that
> was required.
I don't think there was much correction compared to some.
I think my eyes were something like -1 in both plus 3 astimatisium in one
and about 1 in the other.
They don't give you a print out here but at the time I remember asking the
doc the specs.
The pupil size was 6mm. I'll have a go at trying to messure them myself. I
do have a infra red camera too with a tripod so I'll try it.
>
> Flattening the center of the cornea for myopic correction dramatically
> changes the optics of the eye in ways that probably are still not
> fully understood. A large amount of flattening may induce halos.
>
> It may be valuable for you to have a wavefront analysis to see which
> higher order aberrations are elevated. Of course, this needs to be
> administered with your pupils dilated as they are at night when you
> are driving. My bet is that your spherical aberration, coma, and/or
> secondary astigmatism are unusually elevated.
> Depending upon the cause of your halos, it may be possible to resolve
> them with Complex Wavefront Retreatment (CWR), but CWR is surgery and
> you would need to weight the potential benefit against the potential
> risk.
I think I would pass on having more surgery. I see SO well during the day
now that I really wouldn't want to risk that in any way.
The halo's are annoying but I absolutely LOVE seeing so great in the day
now.
> If there is any residual refractive error, the obvious first step
> would be glasses or contacts. I would not be at all surprised if a
> proper fitting of contacts resolves the problem. That is much less
> invasive than more surgery.
I wore contacts years ago and lasted 1 week!! I couldn't stand them so that
ones out. I could handle wearing glasses for night driving if it fixed it.
Maybe I should have another word with the eye doc?
> Alphagan P works very well at reducing the size of the pupil without
> causing a lot of disruption. These eye drops used when needed may be
> a helpful workaround.
Yes I have some here but haven't used them yet. I will try them some time.
After you use them how long does it have a effect??
Thanks for your help Glen.
Regards
Wal
| |
| Glenn - USAEyes.org 2005-05-18, 11:47 am |
| Wal,
I think you may have answered the key question. If you were a low
myope and had high astigmatism (3.00 diopters is high), then my bet is
that you have residual astigmatism at the periphery of the cornea,
rather than higher order aberrations (HOA) induced by undercorrection
at the periphery or an ablation limitation. That would mean your
night vision problem relates more to topography than HOA.
A good manifest AND cyclopegic refraction would be in order. This
should do a good job of determining what refractive error remains.
The optometrists here can advise on what else you may need in this
arena.
Contacts of even a couple of years ago are very different than
contacts of today. The silicone hydrogel lenses let through almost
more air than having no contact. The comfort level is much higher.
Of course, glasses have the advantage of being easy to remove when you
are in a well lit environment. Perhaps some nice stylish "evening
wear" spectacles. 8^)
Someone else who uses Alphagan P can respond, but my understanding is
that Alphagan P reduces the size of the pupil within minutes.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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