Refractive surgery, PRK and LASIK, have evolved and become more common place over the last 10 years. As more of these procedures are performed, the scope of their goals appears to be increasing as well. Initially, patient's desires were to reduce or eliminate their need for eye glasses, but now a new therapeutic approach appears to be on the horizon.

Amblyopia is reduced vision in an eye for a non pathological reason. Among the reasons for amblyopia are an eye turn called strabismus, high prescriptions, and large differences in powers between the two eyes. Any situation that will result in one eye seeing much better then the other can cause amblyopia. Therapy for this condition has always been to blur the vision in the good eye forcing the weaker eye to work harder and stimulate the visual cortex. During the developmental years, birth to 7-8 years of age, the brain is establishing its connections, and once completed amblyopia is much more difficult to treat. The results are much more moderate at best.

Conventional modalities have included patching the good eye or blurring the vision with dilating drops such as atropine. In addition, the weaker eye must wear either a contact lens or thick eye glasses in order to focus light on to the retina permitting the best possible vision. Eye exercises are also required to maximize the stimulation of the weaker eye. Compliance is a major factor for success of this treatment. Since most of these patients are children, parental supervision, and enthusiasm is required. As a result, in many instances the therapeutic outcome is not as successful as desired because either the child is non compliant or the parent is not as diligent. In addition, because of contact lens intolerance or an inability to wear glasses where one lens is much thicker then the other, lack of proper stimulation results in a bad therapeutic outcome.

According to an article published in the July issue of Ocular Surgery News, amblyopia resulting from differences in powers of the eyes affects about 1-2% of the population. Approximately 40% of children 2 years of age with anisometropia (big differences in powers between the two eyes) suffer from amblyopia, while 76% of 5 year olds with the same condition will be amblyopic. The higher the level of the anisometropia; the greater the likelihood and severity of the condition.

Dr. Evelyn Paysse has been conducting a study to determine if PRK would be a better alternative to balancing the refractive differences and thus eliminating the cause of the amblyopia. By having the two eyes the same power it would be much easier for the child to function in his/her daily activities and it would also make the amblyopia treatment easier to perform. Amblyopia therapy must still be done because the PRK does not eliminate the amblyopia, just the difference in power between the eyes. As an alternative to contact lenses or thick eye glasses, PRK would be a permanent solution to equalize the powers in both eyes.

This situation would be of even greater benefit among special needs children suffering from conditions such as Down's Syndrome, cerebral palsy, developmental disorders and other neurobehavioral conditions. The improved visual function would have a positive behavioral impact in these children since they would no longer be living in an isolated visual world.

In summary, while elective surgery should always been minimized in children, it should be considered when the end result can have a life long benefit and result in better vision. When contact lens intolerance exists, and eye glasses can not be worn comfortably, then refractive surgery may be a great alternative. Of course, patient and parent compliance must be present for the best therapeutic results.