PRESBYOND can be performed in people with large pupils, but the risk of night‑time halos and glare is higher and must be carefully discussed.
Issues associated with large pupils
More light passes through peripheral optics.
- Increased likelihood of halos, starbursts, or glare around lights at night
- Greater sensitivity to small optical imperfections or decentration
- Potential impact on night driving and low‑contrast tasks
- Subjective tolerance varies widely between individuals
- Pupil size influences candidacy and planning of laser profiles
Assessment and counselling
Suitability is highly individual.
- Measurement of scotopic pupil size during evaluation
- Review of current night‑vision symptoms and occupational needs
- Consideration of alternatives (for example monovision) if risk seems high
- Advice that occasional spectacles may still help in challenging night conditions
- Shared decision‑making after fully understanding trade‑offs
