Accurate pupillometry is an essential part of the evaluation for refractive surgery. With reports of halos and glare following refractive surgery on many of the prime-time news shows, pupillometry has become one of the preoperative tests that patients expect. It is very clear from the published and anecdotal reports of nighttime glare and halos that a large pupil is the predominant factor leading to these problems.
The need to detect the patients with large pupils as a part of the refractive evaluation makes precise pupillometry measurements crucial. I’ve been involved in a malpractice suit in which the pupils were estimated to be 6 mm (using a Rosenbaum Chart with pupil sizes at the bottom). When accurate
pupillometry was done, they were found to be 7.5 mm. The patient, a commercial pilot with 20/20 postop daytime vision in both eyes, is no longer able to fly because of disabling nighttime glare. His estimated loss of future income, as well as a loss in his quality of life has resulted in a claim of more than $5 million. I have seen the patient and the surgery was done perfectly.
In this article, I’ll review the tools available to refractive surgeons. I have used all of these instruments and will list the features and accuracy of each.