Pediatric Refractive Surgery
Treatment for moderate to high focusing disorders.
What is a refractive error?
The most common vision impairment is caused by errors in refraction, or focus. Refractive errors result when light rays do not come to a focus on the retina, causing the condition of myopia (nearsightedness), hyperopia (farsightedness) or astigmatism.
How are these conditions treated?
The refractive error may be treated with either a laser or a lens implanted into the eye (intraocular lens). The choice of laser vs. intraocular lens depends on the amount of correction needed and the size and shape of the child’s eye. The excimer laser reshapes the corneal surface to correct the focus. The intraocular lens also corrects the focus, but it does so by adding or subtracting power from the natural lens of the eye. The ultimate goal is to eliminate or reduce the need for eyeglasses or contact lenses. The child is under general anesthesia during the surgeries. Both types of surgery are done as outpatient procedures, so the child can return home the same day.
Who can be treated?
Ideal candidates are children having challenges with vision correction through eyeglasses or contact lenses. Suitable candidates also include children with a large difference in prescription treatment per eye.
Additional information about these treatments
Pediatric Implantable Collamer Lens
Visian ICL
Visian ICL is the new generation in vision correction for problems such as myopia and astigmatism. This implantable lens works with your child’s natural eye to correct vision. The procedure treats a wider range of focus errors and may free your child from glasses or contact lenses.
Unlike contact lenses that go on the surface of the eye, the Visian ICL is positioned inside the eye behind the pupil, between the iris (the colored part of the eye) and the natural lens. Unlike laser procedures, the Visian ICL procedure does not remove corneal tissue, but works in harmony with your child’s natural eyes.
Children who are not candidates for Excimer Laser surgery (PRK).
Children with naturally thin corneas and those with high nearsightedness levels are generally advised against a laser correction procedure. Others may be uncomfortable with the idea of removal of their corneal tissue.
Children with neurobehavioral disorders who will not wear glasses.
Children that have trialed glasses and are unable to tolerate wearing them or that are unsuited for contact lens wear may be good candidates for Implantable Contact Lenses (ICL).
Children that have unequal vision.
Children who have unequal refractive power (anisometropia) have a significant prescription in only one eye. The eye with the stronger prescription often loses vision (amblyopia or “lazy eye”).
- An ICL implant is used to treat moderate to high myopia (nearsightedness) as well as astigmatism (irregularly shaped cornea).
- Myopia is a type of focusing error that results in blurry distant vision. Light sent from a distant object focuses in front of the retina, rather than on the retina.
- Astigmatism causes blurred or distorted vision at all distances. Light fails to come to a single focus point on the retina to produce clear vision.
- Depth perception and the field of vision usually improve after surgery because the brain pays better attention to the sight from both eyes. For the same reason, tracking of the eyes also benefits.
- In children with neurobehavioral disorders who will not wear glasses or contacts, visual attention and interest in others may improve substantially.
Before the surgery
Before the surgery your child’s doctor needs to determine their medical eye history and check the anatomy of their eyes. This exam will determine if their eyes are healthy and if they are a good candidate for Visian ICL surgery.
Length of surgery
Generally ICL surgery and the measurements of the eye under anesthesia are completed within 60 minutes.
After surgery
Several office visits after surgery are necessary to track your child’s progress:
- Next day
- 1-2 weeks
- 6-8 weeks
- 6 months
If you live a long distance from St. Louis, discuss alternative pre-operative and post-operative arrangements with your care team.
Can the implant stay in the eye for life?
- Yes. The implant can also be removed or replaced in the future if necessary
Will the implant provide adequate correction if the eye grows?
- Yes, in the majority of cases
- Calculations based on age and eye size are performed to determine the best lens to implant to compensate for eye growth.
What are the risks of implantation, is it safe?
- Complications from lens implantation are rare: increased eye pressure (5%), cataract formation (1%), or infection (0.1%).
- A complication would be treated by eye drops and/or additional surgery
Excimer Laser Surgery for Children
Excimer Laser Surgery is used to treat near or farsightedness (focusing disorders).
These focusing disorders often cause lazy vision (amblyopia) in one eye, or impaired
vision in both eyes. The laser uses cool, ultraviolet light energy to reshape the surface of the cornea (clear, front part of eye). By reshaping the cornea, the laser can reduce or eliminate near or far sightedness.
Laser surgery for children is not performed for cosmetic purposes. This procedure is
appropriate only for children who are ill suited to contact lens wear, and who have persistent difficulty wearing glasses.
- Correcting the focusing disorder helps to improve lazy vision, especially in children under 10 years of age.
- Depth perception and the field of vision usually improve after surgery because the brain pays better attention to the sight from both eyes. For the same reason, tracking of the eyes also benefits.
- In children with neurobehavioral disorders who will not wear glasses, visual attention and interest in others may improve substantially.
Before the surgery
To determine if laser surgery is appropriate for your child, a full vision exam is performed.
During the surgery
Your child will be under sedation during the procedure. An exam will be performed to obtain additional measurements, followed by the laser application which lasts only 1-2 minutes. The whole procedure is generally completed within 30 minutes.
After the laser treatment, a clear soft contact lens is inserted on the eye (which acts as a bandage). Within a few hours of the procedure, your child will be released to go home.
Although most children experience light sensitivity and temporary irritation for a few days, they can resume all normal play and activities. Rubbing the eye should be discouraged for the first few days after surgery.
After the surgery
To prevent scar tissue from forming and to keep the correction stable, your child
will take a multivitamin, with vitamin C daily. An eye drop will be prescribed twice a day for 6 to 12 months.
Several office visits after surgery are necessary to track your child’s progress:
- Next day
- 3-5 days
- 1 month
- 3-6 months
- 1 year
- Annually
If you live a long distance from St. Louis, discuss alternative pre-operative and post-operative arrangements with your care team.
Will laser surgery provide adequate correction if the eye grows?
- Yes, in the majority of cases.
- Calculations based on age and eye anatomy are performed to determine the amount of correction to compensate for eye growth.
What are the risks of laser surgery, is it safe?
- Complications from excimer laser surgery are rare.
- Prolonged or delayed healing (2%) or scarring of the cornea (1%) would be treated by eye drops and/or additional surgery.