LOOKING AT CONTROVERSY SHOULD KIDS HAVE LASIK SURGERY?
The lenses of Zina Sagoo's glasses were, if not Coke-bottle thick, pretty close, and she didn't especially enjoy wearing them. Zina was near-sighted and astigmatic, even though neither her parents nor her three siblings are similarly afflicted.
At first glance, the scenario seems unfortunate, but not especially uncommon. Vision problems such as nearsightedness are genetic traits that can skip a generation. And a 9-year-old who likes the burden of corrective lenses - glasses or contacts - is about as common as a 9-year-old who likes homework.
In ever-expanding numbers, adults with poor vision are having their corneas reshaped through refractive surgical procedures such as radial keratotomy, or RK, photorefractive keratectomy, or PK, and laser-assisted in situ keratomileusis, or LASIK. The question is not whether a child's vision can also be fixed through the same procedures, but rather should it?
Most ophthalmologists emphatically say no, citing a dearth of research and the policy of the U.S. Food and Drug Administration that has approved laser vision correction surgery on adults only. But more and more doctors say there are situations in which pediatric refractive surgery is not only possible, but necessary.
Situations like Zina's.
Born eight weeks prematurely, she received oxygen in the prenatal unit that damaged her vision and caused her to suffer a partial retinal detachment requiring surgery. Despite the best efforts of doctors and therapy to treat the amblyopia - commonly known as ``lazy eye'' - Zina rarely uses her weak right eye.
``She doesn't really know what seeing good is,'' says her mother, May, who lives in Porter Ranch. ``I don't think any child should have a vision disadvantage. It's so unfair.
``When I heard about laser vision correction surgery when it first came out, I thought 'Oh, God, this would be great for her.' But they said don't do it until she's 18. So I decided, as soon as she's 18, this would be my gift to her.''
As things turned out, the wait was shortened considerably. After consulting West Hills pediatric ophthalmologist Dr. Jonathan Davidorf, the Sagoo family decided Zina should get LASIK surgery sooner rather than later. Davidorf, who has written several articles on the topic and presented his findings at the American Society of Cataract and Refractive Surgery annual meeting last year, believes refractive surgery performed on children is now just reaching ``the tip of the iceberg.''
Zina, meanwhile, just knows that the procedure will help her eyes. Why should a child go through laser refractive surgery? For the same reasons an adult would.
``To see better and not worry about glasses or contacts anymore,'' said Zina a few days before her scheduled surgery. ``Is that it, Mom?''
``That's right,'' replied her mother.
Patients like Zina, for whom conventional treatment is unsuccessful, can benefit from laser surgery, says Davidorf. Zina won't be able to throw out her glasses or contacts entirely, but her two eyes will be up at 20/40, and the weaker eye will be put to use. Then Zina gets to go through treatment for her lazy eye - including patching and contacts - again. If everything goes well, she could have another procedure as an adult that would permanently correct her nearsightedness.
``We're trying to improve her best corrected vision,'' says Davidorf. ``There's a window of opportunity that starts closing around age 7 or 8, and we hope it's not closed in Zina's case. By making her eye that is highly astigmatic and extremely nearsighted only mildly nearsighted and normally astigmatic, we can combine what we've done with conventional treatments and get her seeing letters on the eye chart that are smaller than 20/70.''
Zina's situation, Davidorf emphasizes, is one of a select number of cases in which laser surgery for children is appropriate.
``Not all patients will be good candidates,'' says Davidorf. ``I don't want everybody who says, 'I see a little fuzzy,' to call and say, 'Can I get this done?' We're seeing people who have truly hit a wall with regard to their ability to see with glasses or contacts.''
The FDA has approved refractive surgery for adults only, and there is little data to suggest that will change in the near future.
``The FDA would love to have studies done on children,'' says Dr. Peter J. McDonnell, chairman of the department of ophthalmology at the University of California, Irvine. ``If the results seem safe and effective, they would approve it. If (after the procedure) children are rubbing their eyes, getting infected and going blind, the FDA won't approve it.''
You might think that when dealing with a function as precious as vision, parents would be unwilling to submit their children for research studies on vision correction. But McDonnell believes the opposite is true.
``Since there is such a huge genetic influence that causes nearsightedness, a lot of parents have this tremendous feeling of guilt about their child being nearsighted,'' says McDonnell. ``They feel like it's their fault if other kids are picking on their child of if they're having problems with athletics because they need glasses.
``Very often parents will allow kids to have things done to them that are very unproven. The hope is that it will eliminate the problem, treat parents' guilt.''
Dr. Betsy Blechman, like Davidorf an associate professor at UCLA's Jules Stein Eye Institute, believes there are very few cases in which performing a LASIK procedure on a child is necessary. Between patching therapy and the proper use of contact lenses, conscientious parents should be able to help their children work through lazy eye problems, Blechman says.
Ideally, says Blechman, amblyopia should be detected and treated when a child is 3 or 4 years old - not exactly an age when children are particularly patient or good at following directions.
``The eye is growing through age 18, and we're going to weaken the integrity of the eye by doing LASIK,'' says Blechman, an ophthalmologist with Brotman Medical Center in Culver City. ``Maybe on a case-by-case basis, we could do it, but as a blanket statement, no. It has not been approved and it has not been studied.''
Zina Sagoo has a huge braces-filled smile that she likes to flash for photographers taking her picture.
As of a couple of weeks ago, she also has 20/40 vision in both eyes, and no astigmatism. By all accounts, she came through the 30-minute LASIK procedure - which required a local anesthetic - like a champ.
``I'd say her vision is already improved by one-third,'' says her mother. ``She doesn't go up close to the TV anymore. I think she's happier now.''
Davidorf examined her 24 hours after the procedure, and again one week later. He'll monitor her at regular intervals.
``Her vision is already much better than it was before surgery,'' says Davidorf. ``Now we're trying to force her to use that bad eye. As far as an impact on amblyopia, it will take several weeks before we see any significant improvement.''
Photo: (1 -- 2 -- cover -- color) For Zina Sagoo, laser procedure made a difference. But doctors say it's not a viable option for most children
Hans Gutknecht/Staff Photographer
Andy Holzman/Staff Photographer
(3 -- 4) Since Zina's surgery, she has 20/40 vision in both eyes, and no astigmatism. Inset, although reading and homework are easier, she'll still be undergoing treatment for her lazy eye.
Hans Gutknecht/Staff Photographer; inset: Gus Ruelas/Staff Photographer
(5) Dr. John Davidorf explains the LASIK procedure to Zina before her surgery; the girl is among the youngest to have the operation.
(6) Before LASIK surgery, Zina Sagoo keeps a watchful eye on machinery in an exam room at Freedom Vision Center in Encino.
Andy Holzman/Staff Photographer
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|Title Annotation:||L.A. Life|
|Publication:||Daily News (Los Angeles, CA)|
|Date:||May 7, 2001|
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