Refractive surgery in children intended as a therapeutic approach

“I realise that refractive surgery in children is a controversial topic,” said Béatrice Cochener MD, PhD, France. “But I believe it has a definite place in our arsenal in the management of amblyopia and anisometropia.” Speaking at yesterday’s WSPOS Subspecialty Day in Copenhagen, she emphasised that refractive surgery in children is intended as a therapeutic approach, in which the goal is the development or recovery of stereoacuity, not simply spectacle independence.   “In fact, because long-term predictability of refractive outcome is difficult to achieve, spectacle independence is not even a primary goal,” she added.   “Refractive surgery is never the first choice, but rather a last option in case of failure of other optical corrections,” said Dr Cochener. Examples include high anisometropia, psychomotor handicap, keratoconus, severe contact lens intolerance, unilateral cataract and corneal scarring. A particularly good indication is a young patient with keratoconus and atopia in which contact lenses are not tolerated and best corrected visual acuity loss cannot be corrected by glasses. “In these cases, a posterior phakic intraocular lens (IOL), with or without intraocular ring segments, keratoplasty or crosslinking, can offer good results,” she said.   “However, pseudophakia should remain limited to cataract in children, and then potentially a multifocal IOL if possible,” said Dr Cochener. “A possible exception to this rule is refractive lens exchange for unilateral high hyperopia with a small anterior chamber depth,” she said.   “The goal should always remain: maximal efficacy associated with minimal risk,” concluded Dr Cochener.