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Is Laser Eye Surgery OK for Children?


WebMD Health News

Dec. 7, 2000 -- Nicole Sferra is a bright, enthusiastic business major at Chico State University in California. But three years ago she was a 16-year-old who feared sudden blindness would be the result of the bad vision that had plagued her since childhood.

Now she sees without the glasses that she had worn since she was 3 years old. The transformation is due to laser surgery performed to correct farsightedness, also known as hyperopia, in both eyes. Her case may be a step toward using laser in situ keratomileusis, or LASIK, as a standard treatment for certain vision problems in youngsters.

But before that happens, there are many doctors who will need to be convinced that the LASIK surgery should ever be practiced on children. The topic is a highly controversial one.

During the LASIK procedure, surgeons cut a flap of corneal tissue, move it out of the way, then use a laser to remove a piece of the tissue thinner than a human hair. The flap then is returned to its original position.

Jonathan Davidorf, MD, medical director of the Davidorf Eye Group and an ophthalmology clinical instructor at UCLA Jules Stein Eye Institute, believes LASIK surgery could correct sight for children who can't wear glasses or contacts. Initially, this would be for those whose vision is so poor that it hinders their learning abilities and social development, he tells WebMD.

An example of these would be youngsters with anisometropic amblyopia, what's known as lazy eye, who are unable to tolerate glasses or contact lenses. People with this condition have one eye that does not develop normal vision. Usually vision develops until about age 9, but for about 3% of people one eye is much weaker. This creates a vision imbalance between the two eyes and the brain tends to "shut down" the connection to the weaker eye.

Because the connections between the eye and the brain are established by the time you are 7 or 8 years old, it's important to maximize the vision in the weaker eye as soon as possible or the lost vision is unlikely to be regained. Treatments for this condition include wearing a patch over the "good" eye to force the child to use (and strengthen) the weaker eye, contact lenses or glasses, or sometimes surgery.

John Simon, MD, Albany Medical Center's ophthalmology chairman and a professor of pediatric ophthalmology, is just now warming to the idea of LASIK for adults (enough so, he says, that his wife is considering the procedure for her nearsightedness). But for a problem like lazy eye in children, Simon doesn't mince words.

"Glasses work perfectly well to protect what may be the one good eye. People with lazy eye won't have any better correction after LASIK, and you'll still have the compliance problem of not wearing a patch or contact," he tells WebMD.

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