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Kim AJ, Shahraki K, Suh DW. Pediatric refractive surgery: current opinion in ophthalmology. Curr Opin Ophthalmol 2024; 35:292-297. [PMID: 38704713 DOI: 10.1097/icu.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
PURPOSE OF REVIEW Pediatric refractive surgery has been growing at a steady pace since its introduction in the early 1980 s. This article will review common laser refractive surgeries performed on pediatric patients along with controversies regarding the practice. RECENT FINDINGS Pediatric refractive surgery is reserved for a small population of children who fail amblyopic treatment due to high anisometropic refractive errors. Publications over the years have treated these children with various types of laser refractive surgery. SUMMARY Laser pediatric refractive surgery appears to be well tolerated and effective for the population of children that need it. It provides an alternative for anisometropic amblyopia treatment for children who would have otherwise not been able to improve their vision.
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Affiliation(s)
| | - Kourosh Shahraki
- Gavin Herbert Eye Institute (GHEI), University of California at Irvine, Irvine, California, USA
| | - Donny W Suh
- Gavin Herbert Eye Institute (GHEI), University of California at Irvine, Irvine, California, USA
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Myopia: Mechanisms and Strategies to Slow Down Its Progression. J Ophthalmol 2022; 2022:1004977. [PMID: 35747583 PMCID: PMC9213207 DOI: 10.1155/2022/1004977] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/29/2022] [Indexed: 12/15/2022] Open
Abstract
This topical review aimed to update and clarify the behavioral, pharmacological, surgical, and optical strategies that are currently available to prevent and reduce myopia progression. Myopia is the commonest ocular abnormality; reinstated interest is associated with high and increasing prevalence, especially but not, in the Asian population and progressive nature in children. The growing global prevalence seems to be associated with both genetic and environmental factors such as spending more time indoor and using digital devices, particularly during the coronavirus disease 2019 pandemic. Various options have been assessed to prevent or reduce myopia progression in children. In this review, we assess the effects of several types of measures, including spending more time outdoor, optical interventions such as the bifocal/progressive spectacle lenses, soft bifocal/multifocal/extended depth of focus/orthokeratology contact lenses, refractive surgery, and pharmacological treatments. All these options for controlling myopia progression in children have various degrees of efficacy. Atropine, orthokeratology/peripheral defocus contact and spectacle lenses, bifocal or progressive addition spectacles, and increased outdoor activities have been associated with the highest, moderate, and lower efficacies, respectively.
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Etezad-Razavi M, Tafaghodi-Yousefi B, Eslampour A, Kiarudi MY, Najjaran M, Momeni-Moghaddam H, Alio JL. Visual outcomes of photorefractive keratectomy in non-children with anisometropic amblyopia: One-year Follow-up Outcomes. Eur J Ophthalmol 2022; 32:2615-2621. [PMID: 35156869 DOI: 10.1177/11206721211073033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the safety, efficiency, short term stability, and sensory results of photorefractive keratectomy (PRK) in anisometropic in non-compliant children with correction. METHODS Twelve eyes of 12 children with an age range: 6-17 years and anisometropic amblyopia who underwent PRK under general anesthesia to correct the dioptric difference between the eyes were included in this study. A complete ophthalmic assessment including refractive status, uncorrected and corrected distance visual acuity (UDVA & CDVA), and binocular vision status using the Worth 4-dot test and stereopsis were performed before and 1, 3, 6, and 12 months after PRK. RESULTS The mean preoperative CDVA was 0.34 ± 0.24 LogMAR which showed a statistically significant improvement at 12 months (0.20 ± 0.19, p = 0.024) after surgery compared to the preoperative assessment. (p = 0.003) The mean preoperative UDVA was 0.63 ± 0.24 LogMAR that increased to 0.44 ± 0.24, 0.32 ± 0.16, 0.25 ± 0.19, and 0.25 ± 0.19 LogMAR at 1, 3, 6, and 12 months after PRK, respectively. One to three lines improvement in UDVA and CDVA was seen in 10 (83.4%) and 8 eyes (66.7%); while one line UDVA and CDVA loss was seen in one (8.3%) and one (8.3%) eye and unchanged UDVA and CDVA was seen in 1 (8.3%) and 3 eyes (25%), respectively. The mean preoperative stereoacuity was 341.9 ± 245.7 s of arc, which significantly improved to 166.6 ± 87.5 s of arc 12 months after PRK. (p = 0.012). CONCLUSION PRK was an effective surgical alternative to improve visual acuity and stereopsis in anisometropic children who did not cooperate with conventional methods of amblyopia therapy.
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Affiliation(s)
| | | | - Alireza Eslampour
- Eye Research Center, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Y Kiarudi
- Eye Research Center, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marzieh Najjaran
- Department of Optometry, School of Paramedical Sciences, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Momeni-Moghaddam
- Health Promotion Research Center, 48538Zahedan University of Medical Sciences, Zahedan, Iran
| | - Jorge L Alio
- Miguel Hernandez University, Alicante, Spain and Vissum Miranza, Alicante, Spain
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Peyman A, Pourazizi M, Akhlaghi M, Feizi A, Rahimi A, Soltani E. Stereopsis after corneal refractive surgeries: a systematic review and meta-analysis. Int Ophthalmol 2022; 42:2273-2288. [PMID: 35041131 DOI: 10.1007/s10792-021-02201-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To systematically review the published manuscripts on stereopsis after corneal refractive surgery. METHODS The Web of Science, PubMed, Scopus, ProQuest, Clinical Key, Embase, and Cochrane Library were searched for relevant articles published until August 2020. The fixed- or random-effects models were used to estimate the Weighted mean difference (WMD) or Relative risk (RR) and 95% Confidence interval (CI) for postoperative stereopsis changes and incidence when applicable. Meta-regression was conducted for adjusting the effects of potential confounders. RESULTS Seven studies (1266 eyes) in adults and ten studies in pediatrics (259 eyes) were included. In adults, stereopsis improved significantly compared to the preoperative state (WMD = - 27.4, 95% CI = - 40.0, - 14.7; I2 = 97.8%; P < 0.001). In pediatrics, proportion of patients with stereoacuity postoperatively was 2.18 times compared to preoperative evaluation. (RR = 2.18, 95% CI = 1.2, 3.9; I2 = 68.6%, P < 0.001). CONCLUSIONS Stereopsis improves after corneal refractive surgery in adults and pediatrics.
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Affiliation(s)
- Alireza Peyman
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Pourazizi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohamadreza Akhlaghi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Biostatistics and Epidemiology Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Rahimi
- Health Information Research Center, Medical Informatics Department, Faculty of Medical Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Soltani
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Kulikova IL, Pashtaev NP, Batkov YN, Pikusova SM, Terent'eva AE. Femtosecond Laser-Assisted LASIK in Children With Hyperopia and Anisometropic Amblyopia: 7 Years of Follow-up. J Refract Surg 2020; 36:366-373. [PMID: 32521023 DOI: 10.3928/1081597x-20200416-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/14/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze clinical and functional results of femtosecond laser-assisted laser in situ keratomileusis (FSLASIK) in children with hyperopia and unilateral anisome-tropic amblyopia. METHODS The study included 24 patients (24 eyes) aged 5 to 15 years. Before the surgery, the mean manifest refractive spherical equivalent (MRSE) of amblyopic eyes was +3.90 ± 1.60 diopters (D) (range: +1.50 to +6.80 D) and the mean refractive anisometropia was 3.06 ± 1.64 D (range: 0.87 to 7.50 D). Every patient had at least 1 year of ineffective traditional amblyopia treatment before surgery. The mean follow-up period was 7 years (range: 6.9 to 7.4 years). RESULTS At the final follow-up visit, the mean MRSE of operated eyes was +0.41 ± 1.35 D (range: -1.13 to +3.88 D) (P < .001) and anisometropia in MRSE notation was 1.39 ± 1.15 D (range: 0.00 to 4.63 D). Postoperative spherical equivalent was within ±0.50, ±1.00, and ±2.00 D in 31%, 38%, and 92%, respectively. There were no complications. All patients showed a one to seven line gain of corrected distance visual acuity. CONCLUSIONS FS-LASIK was an effective method of hyperopia correction in this cohort of children with amblyopia, resulting in reduction in anisometropia, restoration of refractive balance, and functional improvement in the amblyopic eye when traditional methods failed. [J Refract Surg. 2020;36(6):366-373.].
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Threshold Values of Myopic Anisometropia Causing Loss of Stereopsis. J Ophthalmol 2019; 2019:2654170. [PMID: 31198605 PMCID: PMC6526573 DOI: 10.1155/2019/2654170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/16/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of the study was to determine the threshold values of myopic anisometropia that lead to the loss of stereoacuity in most of patients. Materials and Methods Forty healthy subjects were included in the study. The inclusion criteria were as follows: lack of any functional or morphological ophthalmological disorders, or detectable damage to the visual system, anisometropia equal or less than 0.25 D in a spherical equivalent, and full stereoscopic vision for near and for distance. Myopic anisometropia was evoked by placing different focusing lenses in front of the right eye of the subject in the trial frame. Stereoscopic vision was assessed with the use of the Titmus test (dots) (Stereo Fly Test Stereo Optical Co. Inc.) for near and the Randot test for distance (Distance Randot Stereotest Stereo Optical Co. Inc.). Results The threshold values for different types of myopic anisometropia for the loss of stereopsis in more than 50% of patients were determined. For near, this value was 3 D for sphere and “against the rule astigmatism” and 4 D for “with the rule astigmatism”. For distance, the values were 2 D for sphere and “against the rule astigmatism” and 3 D for “with the rule astigmatism.” Conclusions. Myopic anisometropia of more than 2 D can cause a significant impairment of binocular vision. Stereoacuity at distance is more sensitive to myopic anisometropia than stereoacuity at near. Myopic anisometropia involving “against the rule” astigmatism potentially affects binocularity more than anisometropia with regular astigmatism. A prompt correction of anisometropia of more than 2 D is needed in children to prevent the development of amblyopia.
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Kraus CL, Culican SM. New advances in amblyopia therapy II: refractive therapies. Br J Ophthalmol 2018; 102:1611-1614. [PMID: 29871968 PMCID: PMC6287570 DOI: 10.1136/bjophthalmol-2018-312173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/23/2018] [Indexed: 11/11/2022]
Abstract
The treatment of anisometropic or ametropic amblyopia has traditionally enjoyed a high treatment success rate. Early initiation and consistent use of spectacle correction can completely resolve amblyopia in a majority of patients. For those with anisometropic amblyopia that fail to improve with glasses wear alone, patching or atropine penalisation can lead to equalisation of visual acuity. However, successful treatment requires full-time compliance with refractive correction and this can be a challenge for a patient population that often has one eye with good acuity without correction. Other barriers for a select population with high anisometropic or ametropic amblyopia include rejection of glasses for various reasons including discomfort, behavioural or sensory problems, postural issues and visually significant aniseikonia. When consistent wear of optical correction proves difficult and patching/atropine remains a major obstacle, surgical correction of refractive error has proven success in achieving vision improvement. Acting as a means to achieve spectacle independence or reducing the overall needed refractive correction, refractive surgery can offer a unique treatment option for this patient population. Laser surgery, phakic intraocular lenses and clear lens exchange are three approaches to altering the refractive state of the eye. Each has documented success in improving vision, particularly in populations where glasses wear has not been possible. Surgical correction of refractive error has a risk profile greater than that of more traditional therapies. However, its use in a specific population offers the opportunity for improving visual acuity in children who otherwise have poor outcomes with glasses and patching/atropine alone.
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Affiliation(s)
- Courtney L Kraus
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan M Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Zhang J, Yu KM. Femtosecond laser corneal refractive surgery for the correction of high myopic anisometropic amblyopia in juveniles. Int J Ophthalmol 2017; 10:1678-1685. [PMID: 29181310 DOI: 10.18240/ijo.2017.11.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/01/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effects of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) to correct high myopic anisometropic amblyopia in juvenile patients. METHODS From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK (30 eyes) or SMILE (3 eyes) was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed follow-up examinations at 3d, 1mo, 3mo and the last follow-up time (mean 8.17±3.23mo) after surgery. RESULTS The mean age at surgery was 9.04±3.04y (range 6-16y). The mean spherical equivalent in the amblyopic eyes was significantly decreased from -10.00±2.39 D preoperatively to -0.06±1.06 D at 1mo, -0.19±1.33 D at 3mo and -0.60±1.43 D at approximately 8mo postoperatively (P<0.05 for all). The mean myopic anisometropia was significantly decreased from -9.45±2.33 D preoperatively to +0.37±1.48 D at 1mo, -0.46±1.47 D at 3mo and -0.09±1.83 D at approximately 8mo (P<0.05 for all). The logarithm of the minimum angle of resolution (logMAR) for uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8mo after surgery, respectively. The logMAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles per degree was significantly improved postoperatively (P<0.05 for all). Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients (21.2%) recovered near stereopsis (400″ to 60″) at approximately 8mo after surgery. No intraoperative or postoperative complications occurred in any patient. CONCLUSION FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.
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Affiliation(s)
- Jing Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ke-Ming Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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Zhang J, Li JR, Chen ZD, Yu MB, Yu KM. Phakic posterior chamber intraocular lens for unilateral high myopic amblyopia in Chinese pediatric patients. Int J Ophthalmol 2016; 9:1790-1797. [PMID: 28003981 DOI: 10.18240/ijo.2016.12.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/23/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the outcomes of posterior chamber implantable collamer lens (ICL) implantation in Chinese pediatric patients with unilateral high myopic amblyopia. METHODS Eleven eyes of 11 amblyopic patients aged 11.02±3.34y underwent ICL (model V4, Staar Surgical Inc.) implantation to treat unilateral anisometropia were studied. Visual acuity, cycloplegic refraction, contrast sensitivity, stereopsis, intraocular pressure (IOP), vaulting, corneal endothelial cell count and complications were evaluated. Patients completed follow-up at 3d, 1, 3mo and the last follow-up time (mean 8.18±2.82mo) after surgery. RESULTS The mean myopic anisometropia was -13.70±3.25 D preoperatively and +0.69±2.63 D at 8mo postoperatively. The logMAR corrected distance visual acuity (CDVA) of the amblyopic eye was 1.51±0.72 preoperatively and 0.75±0.40 at 8mo postoperatively. The logMAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by a mean of 0.64, 1.55, 1.82 and 2.64 lines and gained more than 2 lines accounted for 18%, 45%, 45%, 64%, respectively. The contrast sensitivity of 0.5, 1 and 2 cpd in amblyopic eyes was significantly increased after surgery. No patient had near stereopsis recovery. The vaulting at 3 and 8mo was significantly lower than that at 1mo postoperatively. No other intraoperative or postoperative complications were observed, except an acute pupillary block glaucoma happened in a patient at two weeks postoperatively. CONCLUSION This short-term results indicate that ICL implantation can be a promising alternative therapy for high myopic anisometropic amblyopia in pediatric patients who have failed with conventional treatments and not suitable to corneal refraction surgery.
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Affiliation(s)
- Jing Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China; Depertment of Ophthalmology, the East Area of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610110, Sichuan Province, China
| | - Jin-Rong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Zi-Dong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Min-Bin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ke-Ming Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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Gu Y, Xie C, Tong J, Hong N, Shen Y. Pre-operative visual evaluation for implantable collamer lenses in highly myopic eyes. Clin Exp Optom 2014; 97:516-22. [PMID: 25143147 DOI: 10.1111/cxo.12199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/18/2014] [Accepted: 05/19/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate a clinical procedure based on trial rigid gas-permeable (RGP) contact lenses fitting to assess the real pre-operative visual acuity (VA) of highly myopic eyes undergoing surgery with an implantable collamer lens. METHODS Highly myopic eyes with a spectacle visual acuity (SVA) of 0.2 logMAR (6/9.6 Snellen) or worse were enrolled. A trial RGP contact lens with high dioptric power was fitted before collamer lens implantation. The trial contact lens residual refractive error was corrected by spectacle over-refraction to estimate contact lens VA (CLVA). The three-month post-operative uncorrected vision and visual acuities were also measured. The safety and efficacy indices of collamer lens implantation were calculated based on pre-operative SVA and CLVA, respectively. RESULTS The study enrolled 42 patients with 68 highly myopic eyes with a mean pre-operative spherical equivalent of -16.40 ± 4.43 D. The mean pre-operative SVA was 0.38 ± 0.19 logMAR. Pre-operative trial RGP contact lens fitting resulted in a significant improvement of VA (2.02 ± 1.05 lines), which was statistically insignificantly different from the VA with the implantable collamer lens (2.07 ± 0.8 lines). The safety index of collamer lens implantation was 1.70 ± 0.38 in reference to the pre-operative SVA but significantly decreased to 1.02 ± 0.17 in reference to CLVA. Similarly, the efficacy index of 1.17 ± 0.48 on SVA decreased to 0.71 ± 0.28 on CLVA. CONCLUSIONS Trial RGP contact lens fitting was found to indicate the potential implantable collamer lens VA more accurately than spectacle refraction. Consideration should be given to the use a trial RGP contact lens as part of the pre-operative work-up prior to collamer lens implantation in order to provide an assessment of the patient's potential post-operative VA.
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Affiliation(s)
- Yangshun Gu
- Department of Ophthalmology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Myopia onset and progression: can it be prevented? Int Ophthalmol 2013; 34:693-705. [PMID: 24043334 DOI: 10.1007/s10792-013-9844-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/03/2013] [Indexed: 12/28/2022]
Abstract
Myopia is the commonest ocular abnormality and the high and growing prevalence of myopia, especially but not only in Asian populations, as well as its progressive nature in children, has contributed to a recent surge in interest. Such worldwide growing prevalence seems to be associated with increasing educational pressures, combined with life-style changes, which have reduced the time that children spend outdoors. Highly nearsighted people are at greater risk for several vision-threatening problems such as retinal detachments, choroidal neovascularization, cataracts and glaucoma, thus the potential benefits of interventions that can limit or prevent myopia progression would be of remarkable social impact. Our understanding of the regulatory processes that lead an eye to refractive errors is undoubtedly incomplete but has grown enormously in the last decades thanks to the animal studies, observational clinical studies, and randomized clinical trials recently published. In this review we assess the effects of several types of life-style and interventions, including outdoor activities, eye drops, undercorrection of myopia, multifocal spectacles, contact lenses, and refractive surgery on the onset and progression of nearsightedness.
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Abstract
PURPOSE To characterize the axial and off-axis refraction across the horizontal meridian of the visual field before and after myopic laser-assisted in situ keratomileusis (LASIK) surgery. This research took place at the Clinical Ophthalmologic-NovoVisión, Madrid, Spain. METHODS Twenty-six ODs (mean age ± SD = 30.4 ± 4.8 years) of 26 patients who underwent LASIK surgery to treat myopia between -0.75/-3.88 D of spherical equivalent (M) were included in the study. Peripheral refraction was evaluated by an open field auto-refractor before and after LASIK surgery at 3 months. Along with a complete set of examination procedures to assess suitability for treatment, the central and peripheral refractions were measured along the horizontal meridian up to 35° of eccentricity in the nasal and temporal retinal areas in 5° visual field steps. RESULTS Changes in M ranged between 1.85 ± 0.93 D at center to 0.33 ± 0.73 D at 35° in the nasal retina (p < 0.029 for all eccentricities). Treatment induced was symmetric between nasal and temporal visual fields along the horizontal meridian. The degree of myopic increase in relative peripheral refractive error as represented by the spherical equivalent for 30° (r2 = 0.462, p < 0.001) and 35° (r2 = 0.717, p < 0.001) eccentric refraction was correlated with axial spherical equivalent at baseline. CONCLUSIONS Peripheral refraction is affected by myopic LASIK surgery. Unlike orthokeratology, which increases the peripheral myopia, LASIK reduces myopia across the horizontal visual field out to at least 35° from fixation.
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Moran S, O'Keefe M. Refractive Surgery in Children. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:235-9. [PMID: 26107479 DOI: 10.1097/apo.0b013e31825ffff1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Refractive surgery in children is controversial. The main indications are bilateral high ametropia and anisometropia where conventional treatment with spectacles or contact lens is not tolerated. Other reported indications include accommodative strabismus and previous cataract surgery. The most commonly performed procedures currently are surface ablation procedures using excimer laser. The main disadvantage of surface ablation procedures is refractive regression, which is more pronounced in higher degrees of ametropia. More recently, there is a growing number of studies evaluating the safety and effectiveness of phakic intraocular lenses (IOLs) as an alternative surgical management for children who are noncompliant with conventional treatment and unsuitable for laser ablative procedures. The advantages of phakic IOLs are reversibility, predictability, and lack of regression. The principal concern with phakic IOL insertion is long-term endothelial cell loss. Clear lens extraction has been performed in patients with shallow anterior chambers beyond the range of corneal laser refractive procedures; however, major drawbacks include loss of accommodation and significant risk of retinal detachment. In summary, results to date show that refractive surgery can be successfully performed in children and meets an important need in a select subgroup of patients who are recalcitrant to traditional therapy. Issues that remain controversial are the age at which to perform surgery, choice of procedure, need for anesthesia, instability of refractive errors in children, and long-term safety considerations.
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Affiliation(s)
- Sarah Moran
- From the Department of Ophthalmology, Children's University Hospital, Dublin, Ireland
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Paysse EA, Tychsen L, Stahl E. Pediatric refractive surgery: corneal and intraocular techniques and beyond. J AAPOS 2012; 16:291-7. [PMID: 22681949 DOI: 10.1016/j.jaapos.2012.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 12/01/2011] [Accepted: 01/29/2012] [Indexed: 11/16/2022]
Abstract
Refractive surgery has now been used successfully to treat severe anisometropia and isoametropia associated with amblyopia in children who cannot wear standard spectacles or contact lenses. Extraocular techniques include photorefractive keratectomy, laser-assisted subepithelial keratomileusis, and laser-assisted in situ keratomileusis. Intraocular techniques include refractive lensectomy and phakic intraocular lenses and are still being investigated in children for refractive errors outside the treatment dose capabilities of the excimer laser. This workshop discusses the various techniques, how and when to use each, and their risks and benefits. Newer techniques currently being used in adults that may someday be used in children are also introduced.
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Affiliation(s)
- Evelyn A Paysse
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
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Cagil N, Ugurlu N, Cakmak HB, Ilker Kocamis S, Turak D, Simsek S. Photorefractive keratectomy in treatment of refractive amblyopia in the adult population. J Cataract Refract Surg 2011; 37:2167-74. [PMID: 22108111 DOI: 10.1016/j.jcrs.2011.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 06/03/2011] [Accepted: 06/06/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate changes in corrected distance visual acuity (CDVA) after photorefractive keratectomy (PRK) in amblyopic cases. SETTING Ankara Ataturk Training and Research Hospital 1st Ophthalmology Clinic, Ankara, Turkey. DESIGN Retrospective case series. METHODS The medical records of cases of anisometropic amblyopia treated by excimer laser PRK were reviewed. Inclusion criteria were no previous refractive correction, occlusion treatment, or chemical penalization before age 15 years. Anisometropic amblyopia was defined as a more than 2-line difference in CDVA and a refractive error difference greater than 3.00 diopters (D) between 2 eyes of the same patient. Final visual acuity measurements were performed at the end of the sixth postoperative month. RESULTS The study enrolled 16 hyperopic patients and 34 myopic patients with a mean age of 33.3 years. The mean preoperative spherical equivalent was -7.46 D ± 2.90 (SD) in myopic eyes and +4.15 ± 2.56 D in hyperopic eyes. The differences between the preoperative and postoperative uncorrected distance visual acuity and CDVA were statistically significant (P=.001). The mean CDVA was 0.47 ± 0.17 preoperatively and 0.61 ± 0.19 postoperatively. The CDVA decreased in 3 cases (6%), stayed the same in 12 cases (24%), and increased in 35 cases (70%). There was no statistically significant correlation between the severity of amblyopia and the increase in CDVA (r = 0.20, P=.165). CONCLUSION After PRK to eliminate and correct refractive errors in anisometropic amblyopia, visual acuity improved significantly in 70% of adult patients with no previous occlusion or chemical penalization treatment.
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Affiliation(s)
- Nurullah Cagil
- Ankara Ataturk Training and Research Hospital 1st Ophthalmology Clinic, Ankara, Turkey
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Huang PYC, Huang PT, Astle WF, Ingram AD, Hèbert A, Huang J, Ruddell S. Laser-assisted subepithelial keratectomy and photorefractive keratectomy for post-penetrating keratoplasty myopia and astigmatism in adults. J Cataract Refract Surg 2011; 37:335-40. [PMID: 21241918 DOI: 10.1016/j.jcrs.2010.08.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 07/16/2010] [Accepted: 08/10/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate whether laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) achieve effective targeted correction and the extent of post-treatment corneal haze after corneal transplantation. SETTING Nonhospital surgical facility, Calgary, Alberta, Canada. DESIGN Evidence-based manuscript. METHODS This study evaluated visual acuity, refractive error correction, and potential complications after LASEK or PRK to eliminate refractive error differences after penetrating keratoplasty in adults. A Nidek EC-5000 or Technolas 217 excimer laser was used in all treatments. RESULTS At last follow-up (mean 20.50 months post laser), the mean spherical equivalent (SE) decreased from -2.71 diopters (D) ± 4.17 (SD) to -0.54 ± 3.28 D in the LASEK group and from -4.87 ± 3.90 D to -1.82 ± 3.34 D in the PRK group. The mean preoperative uncorrected distance visual acuity (UDVA) was 1.63 ± 0.53 and 1.45 ± 0.64, respectively, and the mean postoperative UDVA, 0.83 ± 0.54 and 0.90 ± 0.55, respectively. The improvement in SE and UDVA was statistically significant in both groups (P < .01). The mean haze (0 to 3 scale) at the last follow-up was 0.46 ± 0.708 in the LASEK group and 0.58 ± 0.776 in the PRK group. CONCLUSIONS The UDVA improved and refractive errors were effectively reduced after LASEK or PRK in eyes with previous PKP. There was no significant difference in the change in SE, UDVA, or corrected distance visual acuity between LASEK and PRK. Some patients had evidence of corneal haze, although the difference between the groups was not significant.
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Alió JL, Wolter NV, Piñero DP, Amparo F, Sari ES, Cankaya C, Laria C. Pediatric Refractive Surgery and Its Role in the Treatment of Amblyopia: Meta-Analysis of the Peer-Reviewed Literature. J Refract Surg 2011; 27:364-74. [DOI: 10.3928/1081597x-20100831-01] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 07/15/2010] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW To evaluate recent literature regarding indications and outcomes for refractive surgery in children, including laser in-situ keratomileusis, laser epithelial keratomileusis, photorefractive keratectomy, and refractive intraocular lens placement. RECENT FINDINGS Refractive surgery in children is controversial. Recent publications have reported refractive surgery to treat strabismus and both ametropic and anisometropic amblyopia. Questions remain as to the age at which to perform the surgery, and which specific procedure to perform. Choice of technique depends on the clinical situation. SUMMARY Refractive surgery is an option for children with amblyopia and strabismus who fail treatment with spectacles or contact lenses. Prospective controlled studies are needed, and longer follow-up will answer questions about the utility and safety of refractive surgery in children.
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Pehere NK, Ramappa RM. Refractive surgery in children: treatment options, outcomes, and controversies. Am J Ophthalmol 2010; 149:870-1; author reply 871. [PMID: 20399936 DOI: 10.1016/j.ajo.2010.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 12/03/2009] [Accepted: 01/25/2010] [Indexed: 11/17/2022]
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Ghanem AA, Nematallah EH, El-Adawy IT, Anwar GM. Facilitation of Amblyopia Management by Laser In Situ Keratomileusis in Children with Myopic Anisometropia. Curr Eye Res 2010; 35:281-6. [DOI: 10.3109/02713680903556551] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Astle WF, Huang PT, Ereifej I, Paszuk A. Laser-assisted subepithelial keratectomy for bilateral hyperopia and hyperopic anisometropic amblyopia in children. J Cataract Refract Surg 2010; 36:260-7. [DOI: 10.1016/j.jcrs.2009.08.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 06/26/2009] [Accepted: 08/10/2009] [Indexed: 11/29/2022]
Affiliation(s)
- William F Astle
- Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail Northwest, Calgary, Alberta T3B 6A8, Canada.
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Ghanem AA, Moad AI, Nematallah EH, El-Adawy IT, Anwar GM. Laser in situ keratomileusis for treated myopic anisometropic amblyopia in children. Saudi J Ophthalmol 2010; 24:3-8. [PMID: 23960866 DOI: 10.1016/j.sjopt.2009.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 10/28/2009] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the effects of laser in situ keratomileusis (LASIK) in decreasing myopic anisometropia in children with spectacles or contact lens intolerance and its validity in facilitating treatment of resultant myopic anisometropic amblyopia. PATIENTS AND METHODS LASIK was performed in 18 eyes of 18 children having myopic anisometropic amblyopia not successfully treated with the standard amblyopia treatment for 6 months. Children were followed up at 1 week, 1, 2, 6, 12, 18 and 24 months. Postoperative amblyopia therapy was continued with occlusion of the dominant eye for 6 h daily for the first 3 months and then for 4 h per day as long as possible. RESULTS The mean spherical equivalent refraction in the operated eye had reduced significantly from -9.08 ± 1.86D preoperatively to -0.97 ± 1.16D at 2 years postoperatively. The mean spherical equivalent in the non-operated fellow eye was -1.0 ± 1.15D preoperatively and -2.50 ± 1.15D at 2 years. The mean spherical equivalent myopic anisometropia was -7.75 ± 2.25D preoperatively and -0.50 ± 0.31D at 2 years, representing a 93.5% reduction in myopic anisometropia. The mean regression value was -2.28 ± 1.62D, however, 18 eyes (72%) were within 3.0D of the fellow eye. The mean BCVA was significantly improved from 0.72 ± 0.13 preoperatively to 0.47 ± 0.17 by 2 years after LASIK with amblyopia treatment. CONCLUSION LASIK is a safe and effective alternative method for correcting myopic anisometropic amblyopia, especially in children with spectacles or contact lens intolerance, with more better visual acuity and binocular vision.
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Affiliation(s)
- Assad A Ghanem
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Frank R, Cowan B, Harrop A, Astle W, McPhalen D. Visual development in infants: visual complications of periocular haemangiomas. J Plast Reconstr Aesthet Surg 2010; 63:1-8. [DOI: 10.1016/j.bjps.2008.08.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 08/13/2008] [Accepted: 08/17/2008] [Indexed: 10/21/2022]
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Daoud YJ, Hutchinson A, Wallace DK, Song J, Kim T. Refractive surgery in children: treatment options, outcomes, and controversies. Am J Ophthalmol 2009; 147:573-582.e2. [PMID: 19327445 DOI: 10.1016/j.ajo.2008.12.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 12/16/2008] [Accepted: 12/17/2008] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Yassine J Daoud
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Abstract
The goal of this article is to review current literature regarding the emerging field of pediatric refractive surgery. This encompasses current thought in adult refractive surgery, published literature in pediatric refractive surgery, and future possibilities for refractive technology in the pediatric population. This study includes a comprehensive review of literature in the general refractive surgery, cornea, and pediatric literature.
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Affiliation(s)
- Erin D Stahl
- Department of Ophthalmology, Childrens Mercy Hospitals and Clinics, Kansas City, USA
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Bibliography. Current world literature. Corneal and external disorders. Curr Opin Ophthalmol 2008; 19:363-6. [PMID: 18545022 DOI: 10.1097/icu.0b013e328308161d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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