LASIK and Teens

16-year-old Rebecca Briggs wears contact lenses, and, like a lot of kids. she doesn’t like them. ” I’m supposed to change them every night, but I usually just leave them in for about a week, because in the morning it’s such a hassle to take them in and out, and put them in”

Rebecca has worn either contacts or glasses since 3 rd grade, but is there another option for her now?

“I asked my dad if I could get LASIK surgery. I would personally want to because wearing contacts is a pain, with sports and just every day routine. So I would be interested in getting it.”

And she’s not alone. Eye doctors say requests for LASIK surgery from teenagers are pouring in.

Teri Nguyen, a Doctor of Optometry, says “I get asked all the time from parents: do you think I can give this to my daughter or son for Christmas? And I have to educate them that this is not something you can just purchase. This is surgery.”

In Ireland, doctors did perform LASIK on teenagers with severe amblyopia, or lazy eye, and it was successful. But doctors in the U.S. insist LASIK on kids is too risky. Dr. Nguyen explains, “With a child’s eye, the anatomy of the eye changes as that child gets older.” For that reason, doctors won’t perform LASIK on kids under 18. And even then, they recommend people wait until their 20’s to get the surgery.

She also says parents need to explain the potential dangers of LASIK surgery. “If you’re going to alter the cornea, you’re going to reshape the cornea to such an extreme that in the future, when that child grows up, they could lose their corneal integrity It can create glare and halos at night, and other symptoms of discomfort and function loss.”

Rebecca understands she has to wait. But she says she’ll get LASIK surgery one day, when it’s safe. “Yes, definitely. I know if I can’t get it anytime soon, I’ll get it when I’m old enough to.”

Eye care professionals say alternatives to LASIK for children are in the works, including a procedure where a contact lens is inserted into the back of the eye, behind the iris. It will be available to adults later this year, and if successful, may be approved for children at some point in the future.

By Larry Eldridge, Jr.
CWK Network, Inc.

Last year in San Francisco, Lasik vision correction surgery was performed on the youngest patient ever in the United States. Dr. Jonathan M. Davidorf, medical director of Davidorf Eye Group, performed the operation on a two-year-old boy with severe amblyopia, or lazy eye. Davidorf had tried all conventional treatments prior to the surgery, with no success. Glasses and contact lenses were also tried, but they didn’t help the patient. Because permanent vision loss is a result of amblyopia left untreated, Davidorf decided to perform the operation. There are certain guidelines that should be used to determine what kinds of pediatric patients may be considered appropriate candidates for surgery, however. According to Davidorf, “Prospective patients are categorized as obligatory, functional or elective. Obligatory cases include children eight years of age and younger with amblyopia due to high myopia (nearsightedness), hyperopia (farsightedness) and/or astigmatism who have failed conventional therapy. Functional patients include glasses and contact lens-intolerant or noncompliant children with significant myopia, hyperopia and/or astigmatism.” Davidorf insists that only children who fall into the obligatory and functional categories should be considered as potential candidates.

By Larry Eldridge, Jr.
CWK Network, Inc.

Normally, doctors are hesitant to perform Lasik surgery on individuals under 18. There are exceptions to most rules, however, and Lasik surgery is no different. In certain instances, as the one seen above, children under the age of 18 may be candidates for the operation. Experts have developed a list of certain things to know about Lasik surgery, no matter the patient’s age.

• You should be at least 18 years old (21 for some lasers), since the vision of people younger than 18 usually continues to change.
• You should not be pregnant or nursing as these conditions might change the measured refraction of the eye.
• You should not be taking certain prescription drugs, such as Accutane or oral prednisone.
• Your eyes must be healthy and your prescription stable. If you’re myopic, you should postpone Lasik until your refraction has stabilized, as myopia may continue to increase in some patients until their mid to late 20s.
• You should be in good general health. Lasik may not be recommended for patients with diabetes, rheumatoid arthritis, lupus, glaucoma, herpes infections of the eye or cataracts. You should discuss this with your surgeon.
• Weigh the risks and rewards. If you’re happy wearing contacts or glasses, you may want to forego the surgery.
• Understand your expectations from the surgery. Are they realistic?
• Ask your doctor if you’re a candidate for monovision – correcting one eye for distance vision and the other eye for near vision. Lasik cannot correct presbyopia so that one eye can see at both distance and near. However, Lasik can be used to correct one eye for distance and the other for near. If you can adjust to this correction, it may eliminate or reduce your need for reading glasses. In some instances, surgery on only one eye is required. If your doctor thinks you’re a candidate, ask about the pros and cons.

Only ophthalmologists are permitted to perform Lasik. Ask your eye doctor for a referral to an ophthalmologist who performs Lasik. Ask your surgeon the following questions:

• How long have you been doing Lasik surgery?
• How much experience do you have with the Lasik procedure?
• How do you define success? What’s your success rate? What is the chance for me (with my correction) to achieve 20/20? How many of your patients have achieved 20/20 or 20/40 vision? How many patients return for enhancements? (In general, five to 15 percent return.)
• What laser will you be using for my surgery? Make sure your surgeon is using a laser approved by the U.S. Food and Drug Administration (FDA). As of this publication’s printing, the FDA has approved five lasers for Lasik. They are manufactured by VISX, Summit, Bausch and Lomb, Nidek and ATC. Contact the FDA for updates.
• What’s involved in after-surgery care?
• Who will handle after-surgery care? Who will be responsible?
• What about risks and possible complications?

Before the surgery, your surgeon should explain to you the risks and possible complications, and potential side effects, including the pros and cons of having one or both eyes done on the same day. This is the “informed consent” process. Some risks and possible complications include:

• Over- or under-correction. These problems can often be improved with glasses, contact lenses and enhancements.
• Corneal scarring, irregular astigmatism (permanent warping of the cornea) and an inability to wear contact lenses.
• Corneal infection.
• Loss of best-corrected visual acuity – that is, you would not be able to see as well after surgery, even with glasses or contacts, as you did with glasses or contacts before surgery.
• A decrease in contrast sensitivity, crispness or sharpness. That means that even though you may have 20/20 vision, objects may appear fuzzy or grayish.
• Problems with night driving that may require glasses.
• Flap problems, including irregular flaps, incomplete flaps, flaps cut off entirely and in-growth of cells under the flap.

The following side effects are possible, but usually disappear over time. In rare situations, they may be permanent.

• Discomfort or pain
• Hazy or blurry vision
• Scratchiness
• Dryness
• Glare
• Halos or starbursts around lights
• Light sensitivity
• Small pink or red patches on the white of the eye

American Academy of Ophthalmology
International Society of Refractive Surgery
U.S. Food and Drug Administration