LASIK appears safe, effective, and stable option for correcting refractory pediatric myopic anisometropia
Anisometropia is a condition in which there is a considerable difference in the refractive power between the two eyes. The prevalence of anisometropia increases between the age of 5 and 15 years, when one eye grows shorter or longer than the other, resulting in hyperopic or myopic anisometropia respectively. Myopic anisometropia of ≥ 4 diopters (D) is a frequent cause of amblyopia due to inequality of the retinal images of both eyes which is known as aniseikonia. When foveal fusion fails to correct aniseikonia, patients suffer from altered binocular vision and decreased stereoacuity. The defocused image from the amblyopic eye is usually suppressed and the severity of amblyopia directly correlates with the magnitude of anisometropia. Anisometropic amblyopia is frequently associated with sensory strabismus and diplopia that increase the depth of amblyopia and further interfere with education, sports, self-esteem, and future career choice.
The basic treatment of pediatric anisometropic amblyopia relies on correcting the refractive error along with modulated occlusion or penalization of the dominant eye. Children may tolerate full binocular glasses correction up to 6 D difference, however, they may not sustain binocular vision due to the associated aniseikonia. If they cannot tolerate full binocular glasses correction, contact lenses can be tried with the advantage of larger visual field and better quality of vision. In the case of contact lenses intolerance and poor compliance, refractive surgery should be considered to preserve the visual functions, eliminating aniseikonia, restoring stereopsis and binocular fusion. Previous studies have demonstrated the short-term and intermediate-term safety and efficacy of refractive surgery in treating pediatric myopic anisometropic amblyopia. This includes photorefractive keratectomy (PRK), laser assisted in situ keratomileusis (LASIK), laser-assisted subepithelial keratectomy (LASEK), implantation of phakic intraocular lenses and refractive lens exchange. The purpose of this study by Hashem and Sheha was to evaluate the long-term safety, effectiveness, and stability of unilateral LASIK in pediatric refractory myopic anisometropic amblyopia.
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