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LASIK for Kids: An Option Whose Time May Be Near

Surgery shows promise for problems that don't respond to traditional treatments

(HealthDay is the new name for HealthScoutNews.)

FRIDAY, Sept. 5, 2003 (HealthDayNews) -- Your child may be a good athlete, but you still worry about an injury from those pesky glasses. Or maybe you fret about your middle schooler, longing desperately to fit in but feeling terribly uncool in high-prescription lenses.

What's a parent to do?

Someday, LASIK surgery might be the answer. After all, more than 1 million American adults a year now have this surgery to reduce their dependence on glasses or contact lenses. But the laser equipment has been approved by the U.S. Food and Drug Administration for use only on those 18 and older, and eye doctors generally follow the government guidelines -- effectively squashing that option for kids.

"Personally, I've done 27,000 LASIK procedures, and only a handful have been in children," says Dr. Robert Maloney, an associate clinical professor of ophthalmology at the University of California, Los Angeles, and a spokesman for the American Academy of Ophthalmology. To be exact, he's done five laser surgeries on children and adolescents.

But the picture could be changing somewhat.

Ophthalmologists have begun experimental studies on LASIK surgery for children and teens, focusing mainly on youngsters with vision problems that traditional treatment doesn't help. For these kids, laser surgery could become the standard treatment within five years, predicts Dr. Jonathan Davidorf, a Southern California ophthalmologist who's leading one of the studies.

What about the young athlete or the middle schooler worrying about geeky glasses? "Absolutely not" anytime soon, Davidorf says.

For one thing, "the risks are different for kids than adults," he says. "Some [risks] are probably lower: halos, glare, dry eye. Younger people are better able to tolerate [these]. But will removing corneal tissue affect stability of the eye long-term?" Studies have not yet provided answers to questions like that, he says.

In LASIK surgery, an eye surgeon uses a laser to permanently change the shape of the cornea, thus changing its focusing power. Davidorf says he doesn't think excising tissue and reshaping the cornea in a still-developing eye will affect its stability. But, again, no one's sure.

The eye continues developing until about the time you stop growing, generally in the late teens or early 20s.

"LASIK corrects an eye, but it doesn't stabilize an eye that's changing," says Maloney. "That's why, in practical terms, we usually don't do LASIK in children."

Except when it comes to kids for whom nothing else has worked. They're prime candidates for the LASIK procedure, Davidorf says, specifically, "kids with a lazy eye caused by a high glasses prescription difference between the two eyes."

"Those kids end up automatically using their better-seeing eye, and when you're young, if you don't use it, you lose it," he says.

To prevent permanent vision loss, doctors turn to patches, eye drops, glasses and contact lenses to try to force a child to use a lazy eye. When conventional options fail, doctors can try something experimental, such as laser surgery.

That's what happened with a 7-year-old patient of Maloney's. The boy, who was very near-sighted in one eye, couldn't wear glasses because of the imbalance between his eyes, and he kept losing contact lenses, costing his parents a fortune, Maloney says.

"The surgery changed his life," he says. "He started doing better in school, and he did better athletically [because] he became more confident on the soccer field."

A 2-year-old patient of Davidorf's had success with LASIK as well. Patching and eye drops did not work, and the child was too young for glasses or contacts. After LASIK surgery, however, the toddler's vision in his lazy eye improved from 20/200 -- which is legally blind -- to 20/40, according to a report on the surgery Davidorf presented last spring at a meeting of the American Society of Cataract and Refractive Surgeons.

Lazy eye, or amblyopia, affects 3 percent to 5 percent of the U.S. population, and traditional treatments fail for about five of every 10,000 kids with the condition, Davidorf says. By comparison, he says, one of every 100,000 children risk developing juvenile onset diabetes, known as type 1 diabetes.

"We're trying to see how the young eye responds to these types of procedures," he says of his LASIK study.

The LASIK option will most likely become more widespread for older adolescents, those 15 to 18 years of age. He expects that to happen within 10 years.

"Their vision may not be quite stabilized yet," Davidorf says, "but we can anticipate future changes and overcorrect in anticipation of them." New eye-test technology that's much more precise "is going to give us confidence to move into treating younger people who aren't yet optimal candidates [for LASIK surgery]," he says.

Adds Maloney: LASIK for some children "can be very gratifying surgery. But here's the caveat. This is not the right thing for the vast majority of children. They're better served by glasses and contacts."

More information

To learn more about children's vision, visit the KidsHealth Web site, sponsored by the Nemours Foundation. For details on LASIK surgery, read Basik Lasik, from the Federal Trade Commission and the American Academy of Ophthalmology.

SOURCES: Jonathan Davidorf, M.D., director, Davidorf Eye Group, West Hills, Calif.; Robert Maloney, M.D., director, Maloney Vision Institute, and associate clinical professor, ophthalmology, University of California, Los Angeles
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