Lazy eye is a neurological disorder, the result of an abnormal stimulation of the brain during the critical period of visual development. Lazy eye is the most common cause of visual decline in childhood and is characterized by reduced spatial vision due to strabismus, deprivation and refractive errors; the latter is one of the most frequent causes, which implies an increased risk of severe vision loss.
The use of crystals is the most commonly used method to treat pediatric refractive errors and lazy eye. However, it is not ideal for all patients.
Until recently, the only therapeutic option for lazy eye was an optical correction with glasses or contact lenses. However, advances in refractive surgery such as LASIK have revolutionized the treatment of refractive errors in adults, but the high prevalence of pediatric refractive errors and the rapid progress of refractive surgery in recent years have aroused great interest not only among ophthalmologists, but also in the parents of children who request information about the possibility of correcting these defects through refractive surgery. The refractive surgery then opens a range of therapeutic possibilities in childhood ametropia.
Can LASIK Fix A Lazy Eye?
A refractive surgery such as LASIK makes a permanent change in the refractive state of the eye through surgical intervention. The normal human eye has two main refractive structures, the cornea and the crystalline. The cornea is responsible for 2/3 of the refractive power of the eye, while the crystalline of 1/3. The pioneers in refractive surgery changed the refractive power of the cornea by mechanical or incisional means; for example, radial keratotomies or arcuate, keratomileusis.
Currently, the corneal refractive power is changed using the Excimer laser, with techniques such as photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) for lazy eye. Doctors cannot change the refractive power of the crystalline, but they can perform its extraction and implant an intraocular lens of the desired dioptric power. In addition, there is another option to change the dioptric power of the eye without touching the cornea or the crystalline: phakic intraocular lenses.
The concept of refractive surgery for lazy eye encompasses all surgical procedures that treat refractive defects to achieve good vision without the need for glasses or contact lenses.
The inclusion criteria usually used are lazy eye patients older than 18 years and refractive stability, which is why this topic is controversial and the risk- benefit for the pediatric patient needs to be evaluated very well. All the pediatric refractive surgery techniques have the same risk as in adults, but at the same time they have different characteristics and make the difference between the child and the adult.
Preoperative examination of children for refractive lazy eye surgery can be a challenge due to lack of cooperation. It is difficult to perform corneal topography, although the foregoing can be substituted to some extent by the use of portable keratometers and pachymeters. Procedures guided by wave front cannot be used for the same reasons.
The child with lazy eye offers poor collaboration, so although this surgery is performed with topical anesthesia, in the pediatric patient exam is performed under general anesthesia, with the complications that this can generate, with exceptions of cooperative children. The use of intravenous anesthetics is preferred to avoid the effect of inhalation anesthetic agents on laser equipment.
Surgery in children with lazy eye is more challenging, due to the small eyelid opening; especially when performing LASIK, there is a greater risk of decentering.
In the postoperative period, pain behavior is a challenge, and the prevention of rubbing the eyes, mainly due to LASIK, is a challenge due to the risk of flap displacement, not to mention compliance with topical treatment, the instillation of eye drops is an arduous task for parents or tutors due to the poor collaboration from pediatric patients.
Refractive correction is one of the necessary components in the treatment of anisometric lazy eye and is usually prescribed along with occluding or penalizing the eye. It is an alternative treatment for patients who do not respond to the conventional treatment and who do not take vigorous behavior when children remain amblyopic.