LASIK May Provide Optimal Treatment for Children With a Range of Vision Problems; First U.S. Surgeon Reports Pediatric LASIK Case in Major Medical Journal.

Business Editors & Health Writers

WEST HILLS, Calif.--(BW HealthWire)--Nov. 20, 2000

LASIK and other refractive surgeries usually reserved for adults may provide the best treatment for children with a range of vision problems, according to research reported in the November issue of the Journal of Cataract & Refractive Surgery.

The report, which is presented in a letter by Jonathan Davidorf, M.D., medical director of Davidorf Eye Group (West Hills) and clinical instructor of ophthalmology at UCLA's Jules Stein Eye Institute, represents the first time a U.S. surgeon has reported the results of LASIK on a patient under 18 years of age in a major medical journal. A small number of previous cases have been reported by surgeons in Egypt, France and India.

In the report, Davidorf presents the case of a glasses- and contact-lens-intolerant 16-year-old girl who underwent LASIK surgery to correct significant farsightedness in both eyes. Nearly two years after surgery, the patient is still performing well without glasses. The report also presents guidelines for when it is, and is not, appropriate to consider performing LASIK on patients whose eyes may still be developing and changing.

"We've got to get beyond the knee-jerk reaction that LASIK isn't appropriate for any patient under 18 years of age," said Davidorf. "It is becoming clear that LASIK and other refractive procedures usually reserved for adults may have merit as viable treatments for children."

Davidorf suggests that prospective pediatric and adolescent LASIK patients should be divided into three categories: obligatory, functional and elective.

Obligatory candidates include children under 7 years of age with certain forms of amblyopia ("lazy eye") -- a condition that affects approximately 3 percent of children in the United States. If left untreated until after the critical vision-growing period, it leads to permanent loss of vision.

While nonsurgical treatments such as thick glasses, contact lenses and eye patches can help improve vision in the amblyopic or "lazy" eye, young children often cannot tolerate or are noncompliant with such treatments.

Functional indications include glasses- and contact-lens- intolerant or noncompliant children with significant myopia (nearsightedness), hyperopia (farsightedness) and/or astigmatism. Surgery will not only improve their vision to help them see in school, but will also enable them to better participate in recreational activities, which may have a positive effect on their social development.

As for children who are adequately treated with glasses or contact lenses, Davidorf believes that it is premature to consider LASIK or other surgical approaches on a purely elective basis. Such patients have no medical necessity for surgery and should not be considered good candidates at this time.

Thus far, the U.S. Food and Drug Administration has approved the lasers used in LASIK for nearsighted adults 18 years and older and farsighted adults ages 21 and older. In practice, however, doctors may use the lasers however -- and on whomever -- they wish on an "off-label" basis.

"As we gain experience in treating the obligatory and functional patients, we will be able to better determine the long-term safety and efficacy of LASIK and other refractive surgery procedures in children," said Davidorf. "In the meantime, doctors should continue to move cautiously."