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    Refractive surgery for special needs children: The time is now

    For many, living in a visual blur promotes fearfulness, blunts social interactions


    Refractive outcomes

    In a study of the efficacy of refractive surgery in this challenging patient population, the primary outcome is the gain in the uncorrected VA, which is the important measurement in children who are noncompliant with glasses. The children are assessed using optotype Early Treatment Diabetic Retinopathy Study charts or the Preferential Looking method and Contrast Acuity Cards. Improvements in eye tracking and visual evoked potentials are recorded in their Pediatric Visual Diagnostic Laboratory.

    Dr. Tychsen reported that following a refractive procedure the patients with myopia gained an average of 1 log unit or 10 lines of vision; the patients with hyperopia gained an average of more than three lines of vision.

    “These gains,” he said, “are comparable to those reported in other North American and western European case series as reviewed in our paper with Paysee et al.”

    Other factors can limit the gains in visual acuity. However, Dr. Tychsen emphasized that comorbidities, such as neurobehavioral disorders (52%), amblyopia (72%), nystagmus (43%), and optic neuropathy (12%), should not be deterrents. “For individual children with a comorbidity, the visual acuity gain may be substantial,” he stated.

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