Is it common to see patterns of laser impacts in the periphery of vision?

Visual Perception of Laser Impacts in Peripheral Vision

It is common to see patterns of laser impacts in the peripheral vision following certain laser procedures, particularly in refractive surgeries that involve peripheral corneal ablation or retinal laser treatments. 1

Types of Laser Procedures and Visual Perception

Refractive Surgery

• Hyperopic Ablation Patterns: When correcting hyperopia, the excimer laser creates a peripheral annular ablation around the central optical zone, resulting in steepening of the central cornea relative to the periphery 1
• These peripheral laser impacts may be perceived in the patient's visual field, especially under certain lighting conditions
• Wavefront-guided and wavefront-optimized techniques attempt to maintain a more prolate corneal shape but may still result in visible patterns in peripheral vision 1

Visual Side Effects

• Visual symptoms including glare, starburst/halo effects (especially at night) are documented side effects of laser procedures 1
• Quality of vision under low-light conditions can be reduced after LASIK, with smaller treatment-zone sizes associated with increased likelihood of visually disturbing halo formation 1
• Treatment zone size is particularly important - smaller zones, especially in high refractive corrections, correlate with greater perception of peripheral laser impacts 1

Factors Affecting Perception of Laser Impacts

Treatment-Related Factors

• Type of laser procedure: Different laser platforms use different proprietary ablative patterns, affecting visual outcomes 1
• Ablation profile: Cross-cylinder and bitoric ablations remove less tissue and may result in different visual perceptions compared to ablations that only steepen the flat meridian or only flatten the steep meridian 1

Patient-Related Factors

• Pupil size: Patients with larger pupils may be more likely to perceive peripheral laser impacts, especially in dim lighting conditions
• Degree of correction: Higher corrections, particularly for hyperopia, may result in more noticeable peripheral visual phenomena 1

Time Course and Management

• Most visual symptoms related to laser impacts improve with time as neural adaptation occurs
• However, in some cases, these visual phenomena may persist for months or years 1
• Management options:
  • Supplemental lubrication
  • Topical cyclosporine eyedrops
  • Punctal occlusion
  • In severe cases, consideration of retreatment with larger optical zones 1

Potential Complications vs. Normal Findings

It's important to differentiate normal perception of laser impacts from potential complications:

• Normal findings: Mild peripheral visual phenomena, especially in dim lighting
• Concerning signs: Significant central scotoma, decreased visual acuity, or persistent severe visual disturbances may indicate complications such as retinal injury 2, 3

Clinical Implications

When evaluating patients reporting visible patterns in peripheral vision after laser procedures:

• Assess the pattern, timing, and severity of visual symptoms
• Perform comprehensive ophthalmologic evaluation including visual acuity, contrast sensitivity, and fundus examination
• For persistent or worsening symptoms, consider imaging with optical coherence tomography to evaluate for structural changes 4

Peripheral visual phenomena following laser procedures are generally expected and typically improve over time, but persistent or severe symptoms warrant further evaluation to rule out complications.