LASIK in Pediatric Eyes

In their article about pediatric laser in situ keratomileusis (LASIK) surgery, Agarwal et al.1 have conducted a pioneering work on the use of LASIK to correct anisomyopic amblyopia. The authors performed surgery with the flying-spot Technolas Keracor 217 laser for refractive errors from –9.0 to –23.0 diopters (D), using an optic zone from 6.0 to 4.0 mm. We wish to express the following concerns regarding LASIK in the pediatric age group: 1. Performing surgery in eyes in which the refractive error is not stable is not a good option. The refractive error may continue to increase as the child grows, and the amblyogenic stimulus will persist. 2. The authors mention that results of LASIK beyond –12.0 D of myopia are not accurate. Yet 13 of 16 patients in their series had myopia of more than –12.0 D. The authors even attempted to correct refractive errors beyond –20.0 D, while current literature limits the use of LASIK to myopia of 15.0 D or less.2–4 3. To achieve full correction in the eyes with high myopia, the authors reduced the optic zone diameter to as small as 4.0 mm. These eyes are likely to have significant glare and severe problems with night vision. 4. There is likely to be marked regression that will continue beyond 12 months (follow-up time in the study), especially in cases in which the optic zone was smaller than 5.0 mm.5 5. There is no mention of the preoperative and postoperative keratometric/topographic data. The authors mention that 2 eyes that had a free cap had a preoperative keratometry of 39.0 D. Yet the attempted correction in these cases was –9.0 D and –11.5 D, which would result in a very flat and optically unstable corneal topography (K ≤ 30.0 D). This is also true of the cases in which the attempted correction was 15.0 D or more. These patients will end up with a mean keratometry of less than 30.0 to 35.0 D, which is not an optimal situation. 6. The corneal topography may become very unsuitable for future contact lens use. In view of the fallacies of pediatric LASIK, these children are likely to have long-term regression, increase in the refractive error with age, significant glare, and decrease in contrast sensitivity, and persistance of the amblyogenic stimulus for which the surgery was performed in the first place. We do not think these children will have a long-term favorable outcome after LASIK. Tanuj Dada MD Rasik B Vajpayee MBBS, MS aNew Delhi, India