PresbyMAX can be performed in people with large pupils, but the risk of night‑time halos and glare must be carefully weighed.
Potential issues with large pupils
More light passes through peripheral optics.
- Increased likelihood of halos, starbursts, or glare around lights at night
- Greater sensitivity to slight imperfections in the multifocal ablation
- Possible impact on night driving or low‑contrast tasks
- Subjective tolerance to these phenomena varies widely
- Large pupils may influence candidacy or laser profile choice
Assessment and counselling
Decisions are highly individual.
- Measurement of scotopic pupil size during assessment
- Discussion of current night‑vision symptoms and expectations
- Consideration of alternative strategies (for example monovision) if risk seems high
- Advice that occasional spectacles may still be helpful in challenging night conditions
- Shared decision‑making after fully understanding trade‑offs
