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Long-Term Data Show LASIK Is Safe, Effective in Children: Presented at AAO-PAAO

By Fred Gebhart

SAN FRANCISCO -- October 27, 2009 -- Ten year follow-up data show that laser-assisted in situ keratomileusis (LASIK) can be safe, effective, and durable in children between the ages of 8 and 15 years. A poster presented at the 2009 Joint Meeting of the American Association of Ophthalmology and the Pan-American Association of Ophthalmology (AAO-PAAO) reviewed 9 eyes in 9 patients who have been followed for at least 10 years.

"The basic message is that LASIK works for these younger patients," Belquiz Nassaralla, MD, PhD, Goiania Eye Institute, Goiania, Brazil, said during her October 25 poster presentation. "If you can't use conventional treatments like contact lenses or glasses in children and teenagers, LASIK should at least be considered."

Dr. Nassaralla treated 9 patients -- 3 boys and 6 girls -- between January and August 1998. She performed LASIK on the eye with the higher refractive error. All of the patients had high anisometropia (>3.5 D) secondary to high myopia or myopic astigmatism. The untreated eye had an uncorrected visual acuity of at least 20/40 and best corrected visual acuity of 20/20. The mean preoperative spherical equivalent refraction with cycloplegia in the untreated eyes was -0.30 D. Surgery was considered because of poor compliance with eyeglasses and unstable contact lens fitting.

Vision in the treated eyes was notably worse. The mean preoperative spherical equivalent refraction with cycloplegia in the treated eyes was -7.63 D. Uncorrected visual acuity was worse than 20/300 and best corrected visual acuity was at least 20/150. Preoperative diagnoses of anisometropia were congenital myopia or myopic astigmatism (66.6%), cataract surgery following trauma (22.2%), and corneal transplantation for corneal scarring (11.1%).

All of the patients received similar procedures, including a mild oral sedative 2 hours before surgery and 2 drops of topical proparacaine 2 to 5 minutes before surgery. LASIK was performed using standard technique and the treated eyes were covered with a transparent shield.

Dr. Nassaralla reported that all patients were examined daily until the corneal epithelium healed as well as at 1 and 4 weeks postoperatively, then every 3 months for the first year. Patients have been re-examined at least annually and all 9 are still being followed, she added.

Ten years following surgery, all of the corneas remain clear, Dr. Nassaralla said. There is no displacement of the flap, and the cut on the cornea was barely detectable by slit lamp microscopy.

Within 3 months following surgery, the mean spherical equivalent refraction had improved from -7.66 D to 0.16 D. Ten years later, mean spherical equivalent refraction is -2.33. Mean anisometropia improved from a preoperative mean of 7.36 D to approximately 0.7 D 3 months following the procedure. Ten years later, it remains at 1.47 D. Corneal topography has shown no decentred ablation. There was a decrease in central corneal power in all 9 treated eyes that corresponds with the change in manifest refraction.

None of the patients has shown decreased best corrected visual acuity over the 10 years of follow-up. Five patients (55.6%) showed improvement in best corrected visual acuity and four (44.4%) showed no change.

Dr. Nassaralla noted that more data are needed to assess the effect of LASIK on paediatric cornea and on the growing eye. She added that the study is being expanded to include more patients and longer follow-up.

[Presentation title: Ten-Year Follow-up of LASIK in Patients 8- to 15-Years-Old. Abstract PO231]

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