Refractive Surgery in Children
What is refractive surgery?
Refractive surgery is surgery to reduce refractive error (nearsightedness, farsightedness and astigmatism). One common refractive surgery procedure is photorefractive keratectomy (PRK). Another is laser in situ keratomileusis (LASIK). Both of these procedures use the excimer laser to reshape the cornea to focus the eye properly. Excimer laser refractive surgery procedures have been used in millions of adults throughout the world for over 30 years with outstanding results.
Laser surgery is now being used very selectively in children who have very high refractive error and refractive amblyopia, haven’t responded to traditional therapy and will have permanent or significant visual impairment if nothing more is done. The types of amblyopia that are appropriate for refractive surgery consideration in children are anisometropic and isoametropic amblyopia.
Amblyopia and Refractive Surgery
The standard treatment of amblyopia involves wearing glasses or contact lenses to correct the refractive error and, when affecting only one eye, forcing the weak eye to work more by either patching the strong eye or by putting a dilating eye drop into the strong eye to blur the vision. Sometimes this treatment is not successful, due to intolerance, nonresponse or noncompliance with the treatment. If this treatment is unsuccessful, refractive surgery can be considered to stabilize the refractive error and give a properly focused image onto the retina, which then transmits this better image to the brain where the vision can improve.
Risks of Photorefractive Keratectomy
The main risk of PRK is corneal haze. It is uncommon when postoperative anti-inflammatory eye drops are used properly after surgery.
The improvement seen after treatment can deteriorate to the point refractive correction in the form of glasses or surgery is needed again. It is usually a much milder prescription than before the PRK.
Another important though extremely rare complication is keratectasia which is progressive thinning of the cornea. It has only been reported a few times in adults and never in children. There is a procedure available to treat keratectasia if it occurs.
Dry eye has been reported in adults though it resolves over a few months. It has not been reported in children following PRK.
Short-term risks of infection, sensitivity to light and scratchy feeling in the eye occur during the first 5-10 days after the PRK.