Dr. Harzok, I've had a little time to think things over and piece information together. Please forgive me for repeating some of the things in my previous posts. The day after cataract surgery my vision was remarkable. Sharp and clear. My pupil was still constricted from surgery. I asked my surgeon about it and he said it was something he did in the operating room the previous morning. (2/9/05)
My pupil was stil constricted three days later when my daughter noticed it when I visited her in her apartment. (2/12/05) At that time my uncorrected vision was still excellent all through the day and even at night. Does a constricted pupil tend to "mask" some of the negative effects of astigmatism, especially at night? I still had astigmatism +.50 /1.50 as I do now. The only difference was my pupil was constricted unlike it is now. Presently, my low light vision is poor. I don't experience severe halos or starburst at night, just poor visual acuity. I plan to try Alphagan P eyedrops at night in a couple weeks just to satisfy my curiosity. If it works at least it will put my mind at ease. My surgeon thinks it's my residual astigmatism. What is your professional opinion? Thank you for your ongoing help in this matter.

Frank

"Does a constricted pupil tend to "mask" some of the negative effects of astigmatism, especially at night?"

Somewhat, by increasing the depth of focus.

"My surgeon thinks it's my residual astigmatism. What is your professional opinion?"

It is a simple matter to put the lens prescription into a trial frame to demonstrate the benefit of correcting the astigmatism. I would not expect Alphagan to provide as much benefit as a lens correction. Even if the pupil could be made small enough to provide better acuity, there is a diminishing return since too small a pupil will not permit enough light to enter the eye for night driving.

The benefit of Alphagan is in limiting the spherical aberrations in eyes that have undergone ablative procedures where the optic zone diameter is smaller than the pupil size. In these cases, even a millimeter or two reduction in pupil size can have a positive impact on the quality of vision. Pupil reduction to counter residual astigmatism would have to be greater.

Dr. Hartzok mentions that even 1 to 2 mm can affect the quality of vision and that works both ways. Dilation of the pupil from dimmer lighting and/or over the counter cold or allergy oral medications can produce pupil dilation and a decrease in quality of vision - this is especially bothersome when ablation zones are smaller.