Long-term development improves after PRK in children with neurobehavioral disorders and isoametropic amblyopia

Issue: June 25, 2015

NEWPORT, R.I. — PRK in children with neurobehavioral disorders and severe isoametropia not only improves visual acuity but also improves communication skills, activities of daily living and socialization, according to a speaker.

Perspective from M. Edward Wilson, MD

In these children with severe refractive error that goes uncorrected because of an inability to wear spectacles, varying levels of visual impairment may result, not unlike form vision deprivation seen with dense cataract, Evelyn A. Paysse, MD, said at the American Ophthalmological Society meeting.

Evelyn A. Paysse

“Just like other sorts of problems in children that used to be thought of as crazy to do, like pediatric cataract, there is something surgical that can be done that normalizes refractive error. ... Think about this type of amblyopia in a different way than your garden-variety amblyopia,” she said. “These children, if they go uncorrected, will have permanent visual impairments.”

Paysse reported a prospective, interventional case series of 15 children aged 4 to 11 years with neurobehavioral disorders, noncompliance with refractive correction and very high refractive error to assess the long-term impact of PRK on behavior.

The primary outcome at 6 months and 36 months postoperatively was change in developmental quotient (DQ) in the subdomains of development, including communication, daily living skills, socialization, motor skills and adaptive skills. Although improvement was seen in all domains, statistically significant improvement was seen in communication, daily living skills and socialization. All subdomain DQs plateaued at 36 months, which implies improvement, Paysse said.

“If the DQ stays the same over time, that means there is some increase in the mental age as well as the biologic age,” she said.

Paysse said there was “excellent response” to the secondary outcomes, which were ophthalmological: changes in uncorrected visual acuity, best corrected visual acuity, cycloplegic refraction and corneal status.

“In essence, parents are overjoyed. This changes their life,” she said. - by Patricia Nale, ELS

Disclosure: Paysse reports no relevant financial disclosures.

Perspective

M. Edward Wilson, MD

In this study, Dr. Paysse and co-workers have provided convincing objective data that children with severe neurobehavioral disorders who are unable to wear glasses can achieve a higher quality of life after refractive surgery. The current study measured a multi-item developmental quotient preoperatively and at 6, 12, 24 and 36 months after surgery.
The take-home message is that PRK dramatically improves socialization and communication skills in severely handicapped children. The clinical implications are that these special individuals need not live in what Lawrence Tychsen has called “a cocoon of blur.” Additional procedures that have also had dramatic results in this population include phakic IOL implantation and refractive lens exchange. This single intervention can have long-term and life-changing benefits.

M. Edward Wilson, MD

OSN Pediatrics/Strabismus Board Member

Disclosures: Wilson reports no relevant financial disclosures.