ICL surgery can be performed in people with large pupils, but the risk of halos, glare, and night‑vision symptoms needs special attention.
Potential issues with large pupils
More light passes through peripheral optics.
- Increased chance of seeing lens edges or optical aberrations in low light
- Greater sensitivity to halos around lights at night
- Higher risk of glare if lens centration or vault is suboptimal
- May influence the choice between different refractive options
- Requires thorough counselling about night‑vision expectations
Mitigating strategies
Planning can reduce symptoms.
- Accurate centration and sizing of the ICL
- Careful assessment of scotopic pupil size during workup
- Exploring impact with simulation and discussion of potential trade‑offs
- Advice on driving and lighting while adapting after surgery
- Considering alternative procedures if very large pupils make visual quality uncertain
