Laser refractive surgery shows promise for pediatric anisometropic amblyopia

For children with anisometropic amblyogenic refractive errors, laser refractive surgery may offer a safe treatment option with equal or better outcomes than standard amblyopia therapies, although long-term effectiveness has yet to be determined.

Study design

This study was a literature review of 11 articles (10 case series, 1 case-control study) with level III evidence. Six studies used LASIK, 1 used PRK, 1 used SMILE, and 3 used a combination of LASIK, PRK, LASEK, or SMILE.

Outcomes

Success was defined as residual refractive error of 1 D or less from the target refraction, and successful outcomes were found in 38–87% of cases. All studies demonstrated an improvement in the magnitude of anisometropia. Of note, regression in refractive error occurred frequently and to a greater degree in myopic eyes, eyes with longer follow-up, and in younger patients. Complications included 2 free flaps in one study; otherwise, there were no adverse events.

Limitations

With only 11 studies in this assessment, each with relatively small sample sizes and highly variable methodologies, it is difficult to accurately compare results. There are challenges unique to refractive surgery in a pediatric population, including logistics such as the need for general anesthesia, a potentially higher rate of complications like flap dislocation and corneal haze, and a more unpredictable healing response. In addition, refractive surgeons may shy away from refractive surgery in younger patients due to unclear refractive stability over time.

Clinical significance

Refractive surgery can be performed successfully in children with anisometropic amblyogenic refractive error. While these results are promising, the effectiveness of refractive surgery in this population should be evaluated in the setting of a prospective randomized controlled trial and followed over time.