Controversies |

Pediatric Refractive Surgery Review

George O. Waring III, MD, FRCOphth
Arch Ophthalmol. 2009;127(6):814-815. doi:10.1001/archophthalmol.2009.94.
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Brown1and Tychsen2convey their disparate viewpoints about refractive surgery in children but agree on some common premises:

  • Spectacle and contact lens intolerance are requisite before any refractive surgery.

  • Refractive surgeons should collaborate with pediatric ophthalmologists—and in more complex cases, pediatricians—to refine clinical measurement and assessment before and after surgery; provide helpful guidance for management, such as the treatment of amblyopia; and sustain broader support for the family and other caretakers, including the refractive surgeon.

  • The precision of visual results achievable with refractive surgery in adults who can fixate during diagnostic testing and surgery cannot be achieved in children.

  • An overriding outcome variable is the change in the child's binocular visual function in everyday life, in addition to standard visual acuity and refractive measures. Their improved vision should enhance their visual awareness, decrease their tentativeness in life, and expand their social interactions.

  • Each author avoids defining the pediatric age group, and the reader is left to assume that they are referring to preteens, since refractive surgery in teenagers (with its inevitable retreatments) is becoming more accepted by refractive surgeons.

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