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Lasik Eye Surgery: Is It Kid-Safe?

Some experts say the procedure is safe enough for limited use in children; others argue that young eyes aren't ready for it.

October 30, 2000|SHARI ROAN | TIMES HEALTH WRITER

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.

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