Refractive surgery an option for children with behavioral disorders, surgeon says

ORLANDO, Fla. – Refractive surgery can be an option for highly myopic children who are not compliant with spectacle use or are contact-lens intolerant due to neurobehavioral disorders, according to a speaker here.

“Refractive surgery was effective in improving functional vision in a subpopulation of children with neurobehavioral disorders who are often difficult to treat or refuse to wear glasses,” said Lawrence Tychsen, MD, at the meeting of the American Association for Pediatric Ophthalmology and Strabismus.

He presented a study of 34 eyes of 17 children with high myopia and “profoundly low functional vision” from the St. Louis Children’s Hospital at Washington University Medical Center in St. Louis. The children were treated with either PRK or laser epithelial keratomileusis or with refractive lens exchange (RLE). A postoperative refractive goal of +1 D was intended in all patients. Preop refractive error ranged from –8.5 D to –23 D (mean –13.55 D). Patients with a refractive error of –12 D or less underwent PRK or LASEK; patients with errors of –13 D or more underwent RLE.

Uncorrected visual acuity improved in all eyes after surgery, Dr. Tychsen said. Seventy-three percent of patients achieved a refraction within ±2 D of emmetropia; 100% achieved refraction within ±3 D. While the outcomes were satisfactory, Dr. Tychsen said, myopic regression occurred in all patients. Regression averaged about a 1 D per year shift in children who underwent surface ablation and 0.55 D per year in children who underwent RLE.