articles Glare and halo phenomena after laser in situ keratomileusis Birgit Lackner, MD, Stefan Pieh, MD, Gerald Schmidinger, MD, Georg Hanselmayer, MD, Christian Simader, MD, PhD, Andreas Reitner, MD, Christian Skorpik, MD Purpose: To simulate and measure subjectively observed glare and halos after laser in situ keratomileusis (LASIK). Setting: University of Vienna, Medical School, Department of Ophthalmology, Vienna, Austria. Methods: In 16 eyes of 10 patients, the best corrected visual acuity (BCVA) and subjectively observed glare and halo size under mesopic conditions were mea- sured before LASIK and 1, 3, and 6 months postoperatively. Infrared pupillogra- phy was used to ensure that all patients had a larger ablation zone than the measured pupil size under mesopic conditions. Results: Preoperatively, the mean Snellen BCVA was 0.88  0.17 (SD) and the mean glare and halo size was 1.97  1.20 square degrees (sqd) before the treat- ment. One month after LASIK, the BCVA was 0.83  0.29 and the mean glare and halo size, 2.61  3.14 sqd. Three months after LASIK, the mean values were 0.90  0.26 and 1.88  2.37 sqd, respectively. Six months after LASIK treatment, they were 0.85  0.28 and 1.30  1.63 sqd, respectively. The 95% confidence interval for the difference between preoperative glare and halo and glare and halo at 6 months was -1.56 to + 0.51 sqd. Conclusion: Subjectively observed glare and halo size after LASIK reached a peak after 1 month and decreased in the following postoperative period. J Cataract Refract Surg 2003; 29:444 – 450 © 2003 ASCRS and ESCRS T he growing impact of laser in situ keratomileusis (LASIK) in the field of refractive surgery derives from the good clinical results it achieves. 1,2–9 Most out- come reports include measurements of high-contrast vi- sual acuity. Other quality-of-vision outcomes such as glare and halos are equally important and are rarely re- ported after LASIK. 10 Most complaints with otherwise successful LASIK and photorefractive keratectomy (PRK) focus on these phenomena, and the incidence of such complaints varies from 3% to 40%. 11 After photorefractive surgery, impaired visual per- formance may be due to ocular monochromatic aberra- tions, 12 light scattering, 13 central islands, or a decentered ablation. 14 Laser in situ keratomileusis pre- serves the epithelial surface, Bowman’s layer, and the anterior stroma of the cornea to photoablate the exposed stroma. The pattern of wound healing after LASIK therefore differs from the healing pattern after PRK and is similar to the situation after mechanical intrastromal keratectomy. 15 The activation of inflammatory cascades is reduced and the extent of wound-healing processes in the corneal stroma, minimized. 16 Adjacent to the ablation zone, corneal wound healing induces new, less organized collagen fibers in random arrays, greater thickness, and dissimilar interfi- brillar spacing. 1 Healing processes and scarring lead to a Accepted for publication August 21, 2002. Reprint requests to Birgit Lackner, MD, University of Vienna, Depart- ment of Ophthalmology, Wa ¨hringer Gu ¨rtel 18-20, A-1090, Vienna, Austria. E-mail: birgit.lackner@akh-wien.ac.at. © 2003 ASCRS and ESCRS 0886-3350/03/$–see front matter Published by Elsevier Science Inc. doi:10.1016/S0886-3350(02)01816-3