Lasik Eye Surgery: Is It Kid-Safe?
As hundreds of thousands of U.S. adults enthusiastically embrace Lasik eye surgery, it’s no surprise that children are beginning to ask, “What about me?”
Eye surgeons report that a small but growing number of teenagers who for various reasons cannot--or don’t want to--wear glasses and contact lenses are seeking Lasik eye surgery. Some doctors question the ethics of performing Lasik on young eyes that are still developing, while also noting that the procedure, despite a strong safety record, is not without risks.
Meanwhile, some researchers have begun performing Lasik on young children with serious eye disorders that have not responded well to other treatments. One such clinical trial is underway in Pittsburgh, and studies are set to begin soon in Los Angeles.
Lasik, which uses an excimer laser to reshape the cornea to correct nearsightedness and farsightedness, already has been studied in parts of Europe and India for children with certain vision problems. Those studies have produced favorable results, prompting some U.S. doctors to reconsider the long-standing belief that children’s eyes are continuously changing and therefore should not be surgically corrected. And doctors are also encouraged by the safety record of some 2.5 million Lasik surgeries in the United States.
Although the long-term effects of Lasik--especially repeated Lasik surgeries--are unknown, short-term studies show a very low risk of serious complications, such as blindness, and a 5% to 15% rate of less serious complications, such as dry eyes, glare or light sensitivity, according to the American Academy of Ophthalmology.
“What’s pushing this interest in children is the safety record in adults,” says Dr. Jonathan Song, a pediatric ophthalmologist at Childrens Hospital in Los Angeles and the Doheny Eye Institute.
The notion that Lasik can’t be performed in the still-developing eye of a child is “too simplistic,” according to Song. Researchers know very little about how and why children’s eyes change as they get older--or about why some kids’ eyes don’t change at all. “There is a whole field of research [that needs] to be opened up,” he says.
Some Balk at Lasik for Children
But other doctors are uneasy with the idea of performing Lasik on children. Even a remote possibility of causing blindness in a child for an elective surgical procedure is reason enough to err on the side of caution, they say.
“As a general rule, it’s not appropriate to do Lasik in children whose eyes are still growing and are not stable,” says Dr. Peter J. McDonnell, chief of ophthalmology at UC Irvine. “Even if treatment seems justified, doctors aren’t sure how well Lasik and other refractive surgeries will work.”
The U.S. Food and Drug Administration has approved the lasers used in Lasik for nearsighted adults ages 18 and older and for farsighted adults ages 21 and older. In actual practice, however, doctors can use the lasers however--and on whomever--they wish.
While Lasik in youths who simply don’t want to wear glasses or contact lenses remains controversial, support is growing for studying Lasik in young children with a vision defect in which one eye is much worse than the other.
The condition, called anisometropia, affects about 1% of children at birth. Most children begin treatment as babies by wearing special glasses or contact lenses to improve vision. They may also wear a patch over the stronger eye to force the weaker eye to work.
If the treatment doesn’t work, the child can develop amblyopia--or lazy eye--in which the brain sends messages to see through the stronger eye and ignore the weaker one. The weaker eye can eventually become useless.
But glasses often don’t work because kids won’t wear them or the treatment is ineffective, says Dr. Jonathan Davidorf, a West Hills ophthalmologist. And getting a toddler to wear contact lenses could be all but impossible. “With Lasik,” he says, “we may be able to make a correction to the bad eye and allow the eyes to balance out. It can give these kids a fighting chance.”
Early Data Seem Promising
A few studies in India and Egypt have been promising, as has one small study underway at the University of Pittsburgh. Five young children with severe anisometropia who had failed conventional therapy have had Lasik to improve vision in the weaker eye, says Dr. Deepinder K. Dhaliwal, chief of refractive surgery at the University of Pittsburgh Medical Center.
None of the children had their vision worsen, while four of the five children had improved vision, says Dhaliwal, who says providing anesthesia to the children is one of the trickiest parts of the procedure.
“After the surgery they continue to do the patching [therapy]. But they are much more accepting of the patch after the surgery,” she says, adding that making the weaker eye even a little better can allow patching therapy to work.
The Pittsburgh team is overjoyed at the response, Dhaliwal says, “because if you don’t intervene in these children early, they will never recover their vision. There is a sensitive period in visual development until about age 9. That is why we were motivated to try this in young children.”
Song is also interested in trying Lasik in children whose corneas have been scarred by infection or an accident.
Children with corneal scarring often need a corneal transplant to preserve vision, says Song. But in children, there is a substantial risk that the body will reject the transplanted cornea.
Lasik might be the answer, he says. “If the scar is on the top layer of the cornea, we think we can laser it down [using Lasik].”
Tracking the progress of children who have had Lasik for anisometropia and corneal scarring will enable researchers to collect data on how the eye responds to such surgery, says Song.
“We need to learn how the cornea heals and changes over time,” he says. “We need to know whether Lasik works in children because children might be able to benefit greatly.”
Some doctors already believe that older kids can benefit from Lasik under the right circumstances. Several local surgeons have done Lasik in teenagers who can’t tolerate or refuse to wear thick glasses or contacts.
“These are people who are not doing well in sports or in school because they are not wearing their glasses or contacts,” says Davidorf. “They are disadvantaged because they are not seeing well. There shouldn’t be a knee-jerk reaction to these kids that they can’t have Lasik.”
Lasik Looks Good to Teenagers
Two years ago, Davidorf performed Lasik on 17-year-old Nicole Sferra after the San Fernando Valley teen, who had previously worn contact lenses, found that she could no longer tolerate them. “I refused to wear my glasses,” says Sferra, now 19. They were thick, and I was too embarrassed. I was walking around blind.”
With the family at “wit’s end,” according to Nicole’s mother, Nancy, they looked into the possibility of Lasik surgery and contacted Davidorf. The doctor warned the Sferras that Nicole’s vision would continue to change and that she would probably need glasses or require another Lasik surgery later.
“I know I may have to have my eyes redone,” says Nicole Sferra. “But I’d do it again in a second. The outcome was amazing.”
In another case, the 16-year-old captain of a high school football team couldn’t tolerate contact lenses and wouldn’t wear glasses during a game. Dr. Robert Maloney, of the Maloney Vision Institute in Los Angeles, agreed to perform Lasik on the youth but warned that the vision correction probably wouldn’t be permanent.
Doctors who treat teens can take two approaches to correcting their vision. They can correct the current vision, knowing another surgery probably will be required in several years as the eyes change. Or they can over-correct the vision in anticipation that their eyesight will worsen for a few more years.
Still, most doctors would agree it’s controversial to perform Lasik on teens who just don’t like to wear contacts or glasses.
But some doctors predict attitudes will change if research demonstrates the effectiveness of laser eye surgeries for children and if, as expected, the procedures become safer and reversible as the technology improves.
“When contact lenses first came out, people said we shouldn’t give them to children,” says Song. “I think the same thing will hold true for Lasik. . . . In the long run, I think laser surgery in children will become common.”
