Pediatric LASIK safe, effective, stable over 10 years

HONG KONG — LASIK in children was shown to be safe, effective and fairly stable over 10 years of follow-up in a long-term study presented here.

"LASIK in children has the same efficacy, predictability and safety margin of others. Of course, your nomogram should be changed depending on the condition of the other eye," Osama Ibrahim, MD, said at the World Ophthalmology Congress. Dr. Ibrahim said he has been performing surgical refractive procedures on pediatric patients since the introduction of refractive keratometry and has completed more than 800 LASIK cases to treat myopia, hyperopia and astigmatism.

Osama Ibrahim

In the study he presented, Dr. Ibrahim showed safety, efficacy and stability data for 264 eyes of 264 patients who all had 10-year follow-up data.

Parameters of success in this study were the ability to wear spectacles, best corrected visual acuity, the ability to resume or maintain occlusion therapy and the stability of the procedure, he said. He reminded the audience that he only performs unilateral LASIK in children in hopes that they can resume their vision therapy, not in an effort to reach emmetropia.

Preoperatively, about one-third of the patients could see 20/100 or better and the majority had a BCVA of less than 20/100.

"After LASIK, we were able to achieve 27% to 20/20 best corrected vision," he said. "About half could see 20/40, and two-thirds were able to see 20/100."

None of the group lost any BCVA, and the majority of patients gained lines. Two-thirds gained at least one line, and one-third of patients gained more than three lines of BCVA.

"Stability was very interesting," Dr. Ibrahim said. "There was reasonable stabilization up to 3 years, and then when they reached the age of puberty and normal growth, there was additional regression up to 10 years."

A striking fact of the stability was that patients who had residual myopia continued to regress or have progressive myopia while patients who received overcorrection had less regression or less progression as compared with the non-operated eye, he added. "Remember that pediatric LASIK is not to get rid of glasses. It's not to avoid the occlusion therapy, as most of the parents would love, and it's not to stop the progression of myopia. And definitely it's not for bilateral patients. It's only to help these poor patients to correct their anisometropia and help them to wear the spectacles," Dr. Ibrahim said.