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Refractive surgery improves amblyopia in older children
 Rebecca S. Leenheer |
SAN DIEGO — In older children who are noncompliant with wearing their glasses, topical refractive surgery is an option, one speaker said here.
Rebecca S. Leenheer, MD, gave results of a prospective interventional case series at the American Association for Pediatric Ophthalmology and Strabismus meeting, in which 10 children aged 7 to 13 years underwent PRK for hyperopic anisometropic amblyopia.
"Hyperopic anisometropic amblyopia is commonly found in the pediatric ophthalmologist's office," Dr. Leenheer said. "The traditional therapy, we know, is refractive correction, followed by penalization of the sound eye." However, she said, older children sometimes will not wear their glasses because their sound eye has excellent vision.
In the study, PRK was done with topical anesthesia using the Visx Star 2 excimer laser (Abbott Medical Optics), with the endothelium removed with alcohol. In the average follow-up of 2.5 years, no corneal instability or irregular astigmatism was found.
"What's unique about our study is that the patients underwent topical anesthesia ... and they had no pain or complications," Dr. Leenheer said. At the end of the study, all patients had improved stereoacuity.
"PRK for hyperopic anisometropic amblyopia appears to be safe with no long-term complications," she said.
- Disclosure: Dr. Leenheer reports no financial disclosures relevant to this presentation.
The clinical importance of this study is that for select older children, photorefractive keratectomy can be performed with topical anesthesia and good results were obtained. It is reassuring that no cases of major corneal haze or instability were seen, and gains in visual performance were noted. However, as Dr. Leenheer notes, standard treatment for refractive amblyopia is correction with spectacles (or contact lens) and penalization, which is successful for the majority of children with this condition. It would be difficult to translate the same benefits of PRK to younger children, who likely would not be able to undergo this procedure with topical anesthesia, who would not be expected to have refractive stability, and who may have a more exuberant inflammatory reaction with resultant corneal haze and poor tolerance for longer-term topical steroids.
– Deborah K. Vanderveen, MD
Children’s Hospital Boston and Harvard Medical School
Disclosure: Dr.
Vanderveen is part of a clinical research study supported by Alcon.