Purpose of Review
This review summarizes refractive surgery options in the pediatric population. It addresses treatment for children with refractive amblyopia unamenable to spectacles and contact lenses. Procedures discussed include laser refractive surgery, phakic intraocular lenses (pIOL), and clear lens exchange. The review also discusses advancements in the treatment of pediatric keratoconus: corneal crosslinking and corneal intrastromal ring segments, both of which can lead to improvements in best corrected visual acuity (BCVA).
While off label, refractive surgery procedures such as laser refractive surgery, pIOLs, and clear lens exchange can be used in amblyopic eyes, resistant to traditional therapy, to improve BCVA and stereopsis. Pediatric corneal crosslinking (CXL), also off label, has led to improvements in keratometry values and BCVA in this vulnerable population.
Refractive surgery is beneficial to a subset of children who would otherwise develop dense amblyopia in the setting of difficulty with traditional therapies. While vision may ultimately be limited by a number of factors, including amblyopia, refractive surgery can maximize visual potential. CXL is of clear benefit to children with keratoconus, who are more likely to progress and ultimately need a corneal transplant than adults with keratoconus. There are unique considerations for the pediatric population in both clinical and surgical management and these should be discussed with patients and their families.
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•• Abdelmassih Y, El-Khoury S, Dirani A, Antonios R, Fadlallah A, Cherfan CG, et al. Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Crosslinking in Pediatric Keratoconus. Am J Ophthalmol. 2017; This series reviewed 17 eyes of 12 patients who received intracorneal ring segments followed by crosslinking for keratoconus. Refractive measures including keratometry and visual acuity improved. The combined procedure prevented keratoconus progression at 4-year follow-up.
Conflict of Interest
Danielle Trief and Leejee Suh declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Refractive Surgery: From Laser to Intraocular Lenses
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Trief, D., Suh, L.H. Refractive Surgery in Pediatric Patients. Curr Ophthalmol Rep 5, 216–224 (2017). https://doi.org/10.1007/s40135-017-0147-y