Refractive surgery for children: Laser, implants, current results and future directions

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4 Scopus citations


Two groups of visually impaired children now benefit from refractive surgery and stand to further benefit with future advances. These children have difficulties with spectacle-wear and are unsuitable for contact lens-wear. The majority are neurologically normal and have anisometropic amblyopia. They are treated by advanced surface ablation using the excimer laser (photorefractive keratectomy or laser-assisted subepithelial keratomilieusis). Surface ablation is safe in children; the drawback is the high rate of pediatric refractive regression (more pronounced for myopia > 10.0 D, and hyperopia > 4.5 D). Ametropia beyond this range may be treated using phakic intraocular lens implantation or clear lens extraction, with or without implantation of a posterior chamber intraocular lens (refractive lens exchange). The minority are neurobehaviorally impaired children (e.g., cerebral palsy, autism, Angelman syndrome, Down syndrome and mental retardation) with high bilateral ametropia. Spectacle noncompliance relegates them to a blurred level of legal blindness, exacerbating their handicaps. Refractive surgery, performed using the same techniques, can dramatically improve their quality of life.

Original languageEnglish
Pages (from-to)635-643
Number of pages9
JournalExpert Review of Ophthalmology
Issue number6
StatePublished - 2008


  • Amblyopia
  • Binocularity
  • Excimer laser
  • Hyperopia
  • Intraocular lens
  • Legal blindness
  • Myopia
  • Pediatric
  • Visual impairment


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