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  • Laser Refractive Surgery May Improve Amblyopia

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, November 2022

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    For an Academy Ophthalmic Technology Assessment, Cavuoto et al. reviewed literature on the effectiveness and safety of laser refractive surgery for treating anisometropic amblyogenic refractive error in children. Although their analysis of relevant studies found variations in the ability of this surgery to address anisome­tropic amblyogen­ic refractive error, the magnitude of anisometro­pia was reduced. However, improvement of amblyopia did not necessarily correlate with refractive improvement. Most complications of the surgery were not serious.

    For this review, the authors searched PubMed in October 2021 for all English-language publications on the topic. Of 137 potential results, 69 articles quali­fied for full-text review, and 12 met all criteria for inclusion. The panel meth­odologist assigned a level of evidence to each study using Academy guidelines.Each of the 12 studies represented evidence level 3. Ten were case series, and two were case-control studies. Six studies involved LASIK, two evaluated PRK, and one assessed refractive/small incision lenticule extraction (ReLEx Smile). The others involved some com­bination of LASIK, PRK, laser epithelial keratomileusis, or ReLEx Smile. Five studies focused on anisometropic myo­pia, two concentrated on anisometropic hyperopia, and the remainder had a mix of patients with either condition.

    Although VA improved in all 12 studies, the amount of improvement varied widely, as did the assessment parameters. The definition of success­ful outcome used in this review was residual refractive error within 1 D of the target refraction, which also was the most common metric among the 12 studies. The proportion of suc­cessful outcomes ranged from 27% to 89%, and the mean follow-up period ranged from four months to seven years. Despite these vast differences, the magnitude of anisometropia improved in every study. Regression of refractive error occurred more frequently—and to a greater degree—in younger chil­dren, in eyes with myopia, and in eyes with relatively longer follow-up. The only serious complications were two free flaps (in the same study). The most common adverse effects were striae and corneal haze.

    “Laser refractive surgery may ad­dress amblyogenic refractive error in children,” said the authors, who noted that it may decrease anisometropia. They acknowledged that large well-de­signed prospective studies are needed to fully clarify the role of refractive surgery in children and its potential effect on amblyopia.

    The original article can be found here.