Refractive Eye Surgery in Children

Posted By on Aug 20, 2018 in General, LASIK Surgery | 0 comments

Neither the FDA nor the American Academy of Ophthalmology recommend a standard practice of performing refractive surgery on the eyes of children. The FDA sets the lower limit of best practice at the age of 18 years. The American Academy of Ophthalmology takes the stance of Preferred Practice Pattern. What that means for ophthalmologists is that the decision remains in their practices. What the AAO states for younger ages under 18 years stays a contraindication. LASIK benefits a select group of children and continues to be experimental in that age range.  Not enough studies have been done for organizations and the government to declare it standard practice. For children for whom LASIK might be an option, the decision comes from a clinic like Houston LASIK.

Why all the precautions?

Children’s eyes do not fully develop until they reach adulthood. As children grow the eyes adjust, adapt, and even change shape. Any surgery done in most cases would temporarily improve vision. Some conditions that affect eyesight improve with age while other conditions worsen. Laser eye surgery carries a certain amount of risk and even with the best preparation can cause an issue. If a child has some eyesight and the probability of success low for the surgery, then in most cases it should not be done. It takes a highly knowledgeable ophthalmologist to make the decision or attempt the operation. The surgical equipment because of the smaller size of the eye operated on must be extremely precise.

Which children do receive LASIK surgery?

A place in pediatrics does exist for LASIK surgery in Houston. For children with severe eye conditions glasses, contact lenses or treatments that did not work then it becomes possible that laser eye surgery can help with eyesight in most cases.  The surgery comes with the understanding when the child becomes an adult they may have to have the procedure again. In those cases, the benefits far outweigh the risks. One of the pioneers in the field of pediatric LASIK surgery Dr. Davidorf did several surgeries on children. He recommends a case by case basis. Dr. Davidorf case involved a Jr. High girl who needed a severe bilateral high hyperopia corrected. The surgery worked well, but as Dr. Davidorf predicted at the end of the college years, the surgery had to be done again since the eyes grew. He has operated on a 7-1/2-year-old female who had treatment-resistant amblyopia successfully. Dr. Davidorf emphatically states LASIK surgery in children should not be standardized but a case by case basis determined by the ophthalmologist doing the operation.

Recent times

In 2016, an article from The Knights of Templar Eye Foundation for its Pediatric Ophthalmology Education center by Dr. Evelyn Paysse presented arguments for LASIK to correct a severe refractive error in children with amblyopia. These youngsters failed all standard therapy. Current amblyopia treatment involves patching, glasses, contact lenses and atropine. It works well mostly. A few children do not respond or cannot cooperate at the level needed to have success with the standard therapy. Also, the refractive error with the amblyopia has such severity that standard therapy will not work. Without treatment will have a visual acuity of 20/150 or worse. World literature shows examples of excimer lasers used nearly 20 years with 800 plus cases and phakic IOL/lens exchange around 100 cases. All had improved vision and reduced refractive error. If pediatric patients are chosen carefully complications are rare. Refractive eye surgery in specific cases remains a viable treatment for some children.


Houston Lasik leads in providing premium LASIK technologies to Houston, Sugar Land, and the surrounding region. The center’s award-winning medical director introduced revolutionary technologies such as iLASIK to the region. This technology is used by NASA astronauts, Navy SEALS and Air Force fighter pilots. At Houston Lasik, you can now receive the same treatment. For more information, please call (281) 240-0478.

J Cataract Refrac Surg 2000;26(11):1567–1568.