Children May Be Ideal Candidates for LASIK, Implantable Contact Lenses and Other Refractive Surgery Procedures Usually Reserved for Adult Patients.

Health/Medical Editors & Writers

WEST HILLS, Calif./BOSTON--(BW HealthWire)--May 19, 2000

Early Surgery Can Help Ensure Normal Eye Development and Eliminate Adverse Effects of Glasses and Contact Lenses on Pediatric/Adolescent

Patients

Despite the challenges inherent in performing vision correction surgery on children, a presentation given at the annual meeting of The American Society of Cataract and Refractive Surgery (ASCRS) suggests that corrective surgeries usually reserved for adults may provide the best treatment for pediatric and adolescent patients with a range of vision problems.

The presentation (titled "LASIK in Adolescents for the Correction of High Hyperopia" -- ASCRS Poster Presentation No. 21; Saturday, May 20, 7:30 a.m.-12:00 p.m.) was authored by Jonathan M. Davidorf, M.D., medical director of Davidorf Eye Group (West Hills, Calif.) and clinical instructor of Ophthalmology at UCLA School of Medicine, Jules Stein Eye Institute.

While nearly all vision impaired pediatric and adolescent patients can be viewed as prospective candidates for refractive surgery, children under seven years of age suffering from amblyopia ("lazy eye") are likely to achieve the most immediate and significant benefits.

Amblyopia is a serious vision problem that affects approximately three to five percent of all children in the United States. If left untreated until after the critical vision-growing period (usually 7-8 years of age), it can lead to permanent loss of vision. In the case of amblyopia, refractive surgery represents a vastly superior alternative to glasses or conventional contact lenses, which children often fail to use as directed.

"There is no question that the majority of children with amblyopia should be treated with LASIK or implantable contact lenses if they are not properly wearing their corrective lenses," said Davidorf. "The rewards of surgery far outweigh the risks given that children with severe amblyopia who are not aggressively treated will assuredly wind up with a lifetime of reduced vision."

Until now, children have not been viewed as good candidates for refractive surgery, particularly LASIK, because the surgery requires the patient to remain still and adhere to the surgeon's instructions to focus on the laser beam. Recent advances in LASIK techniques that provide better predictability and stability have reduced this problem.

For infants and younger children, implantable contact lenses may be an even more attractive option than LASIK. While LASIK requires patient cooperation, implant surgery under general anesthesia can be a totally passive experience for the patient. Additionally, the implants are exchangeable and can be replaced to accommodate refractive changes that occur over time. Currently, children with amblyopia and other refractive errors may be treated on an "off-label" basis with LASIK, but not with implantable contact lenses, as the implants are not yet FDA approved. Families choosing the implants are typically forced to have the surgery done in neighboring countries.

Davidorf believes that most surgeons will soon begin to offer refractive surgery to children who are deemed contact lens-intolerant or otherwise not good candidates for other non-surgical treatments. He also advocates the more controversial view that pediatric and adolescent patients with a far wider range of vision disorders may be good candidates for refractive surgery on a functional or elective basis.

Functional indications include patients with significant anisometropia (unequal refractive error in each eye) and esotropia (one or more crossed eyes). Surgery will not only improve these patients' overall visual performance, but will also enable some to better participate in recreational or sporting activities, which may have a positive impact on their social development.

As for children who are capable of wearing contact lenses or who can achieve adequate vision with glasses and other non-surgical treatments, Davidorf believes the issue of elective refractive surgery will continue to be a subject of intense debate for some time to come.

"When it comes to treating children with serious vision disorders, refractive surgery should immediately be viewed as a viable, and in many cases optimal, treatment," said Davidorf. "As an elective procedure, doctors will need to continue to move cautiously before making refractive surgery the standard of care for pediatric and adolescent patients."

About Jonathan Davidorf, M.D.

Davidorf is medical director of Davidorf Eye Group (West Hills, Calif.). He also serves as a clinical instructor at UCLA's Jules Stein Eye Institute. Among his many firsts, Davidorf co-authored the world's first textbook on LASIK. He was also the first North American surgeon to perform Bioptics vision correction surgery (a combination of an implantable contact lens with LASIK), and the first surgeon in California to perform LASIK for farsightedness.

Davidorf is actively involved in the development of new refractive surgical techniques and instruments. He has served as a clinical investigator for many LASIK studies, Conductive Keratoplasty (CK) and the Artisan Phakic Introcular Lens (IOL). Davidorf Eye Group is located at 7230 Medical Center Drive, Suite 201, West Hills, CA 91307; [phone]; www.davidorf.com.

About ASCRS

The American Society of Cataract and Refractive Surgery is an international educational and scientific organization whose member ophthalmologists specialize in cataract and refractive surgery. ASCRS members are recognized leaders and innovators in ophthalmic surgery worldwide.