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Refractive surgery in children: treatment options, outcomes, and controversies

Yassine J Daoud1, Amy Hutchinson, David K Wallace

  • 1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina 27710, USA.

American Journal of Ophthalmology
|March 31, 2009
PubMed

Insights

Refractive surgery shows promise for treating pediatric refractive errors like severe myopia, but more research is needed. Current options like LASIK, PRK, and LASEK have limitations, with phakic IOLs as an alternative for extreme cases.

Area of Science:

  • Ophthalmology
  • Pediatric Ophthalmology
  • Surgical Innovation

Background:

  • Pediatric refractive errors, including myopia, hyperopia, and anisometropia, can lead to amblyopia if untreated.
  • Conventional treatments for pediatric refractive errors have limitations, particularly in severe or resistant cases.

Purpose of the Study:

  • To review the historical treatment of pediatric refractive errors.
  • To evaluate recent advancements in refractive surgery for treating children.

Main Methods:

  • Comprehensive literature search of MEDLINE, Cochrane Library, and CINAHL databases.
  • Inclusion of English-language articles from 1950 to 2007 using specific keywords and MeSH terms related to pediatric refractive errors and surgical techniques.
  • Bibliography review of identified articles.

Main Results:

  • No large-scale, long-term controlled trials exist for pediatric refractive surgery.
  • Laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and laser epithelial keratomileusis (LASEK) demonstrate intermediate positive outcomes in children with refractive amblyopia.
  • Corneal haze and myopic regression are primary complications, especially in cases exceeding 12 diopters of myopia.

Conclusions:

  • Refractive surgery is a viable option for pediatric patients with severe anisometropia or high bilateral ametropia unresponsive to traditional therapies.
  • Further investigation through large, prospective, multicenter, randomized controlled trials is essential for broader ophthalmic community adoption.
  • Phakic intraocular lenses (IOLs) or clear lens extraction with IOL implantation are potential alternatives for managing extremely high myopia in children.
Abstract

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