Refractive Surgery in Children: Treatment Options, Outcomes, and Controversies

Purpose: To summarize the evolution of the treatment of pediatric refractive errors, with an emphasis on recent advancements in the use of refractive surgery to treat children. Design: Literature review. Methods: We searched MEDLINE (1950 through October 2007), the Cochrane library (December through October 2007), and the Cumulative Index for Nursing and Allied Health Literature (December 1982 through October 2007) for English language articles using the following search strategy with MeSH terms and key words: pediatric refractive errors and amblyopia, anisometropia, hyperopia, myopia, laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), excimer laser, refractive intraocular lens (IOL). We also searched the bibliographies of all identified articles. Results: No multicenter, long-term, controlled trial has been published on the use of refractive surgery in children. The current literature shows that LASIK, PRK, and LASEK show promising results in children with refractive amblyopia over the intermediate follow-up period. Corneal haze and myopic regression are the main complications, especially in very high myopia (> 12 diopters). In such patients with extremely high myopia, small studies have reported phakic IOLs or clear lens extraction with or without IOL implantation to be a useful alternative. Conclusions: Refractive surgery is appropriate in children with severe anisometropia or bilateral high ametropia that is resistant to conventional therapy. More information is needed before pediatric refractive surgery can be widely adopted by the ophthalmic community. This could be achieved with a large, prospective, multicenter, randomized, controlled clinical trial.