Syed M Asad Ali.
Future trends in the management of children with refractive errors.
Al-Shifa J Ophthalmol Jan ;8(0):52-4.

The correctable vision impairment is a global challenge. World Health Organization (WHO) estimates a total of 153 million people (range of uncertainty: 123million to 184million) visually impaired from uncorrected refractive errors of whom eight million are blind1. The data on prevalence of blindness due to refractive errors is not available easily because most studies define blindness in terms of best corrected vision. According to WHO there are 12.811 million visually impaired children due to uncorrected refractive errors in age between 5 and 15 years. The world prevalence in this age is 0.97 percent. Almost half of these children are in China. Second highest incidence is in India with 1.61 million children. The refractive error study in children (RESC) was conducted in China, Nepal, Chile, India, South Africa and Malaysia. It was a population based study with logarithm of the minimal angle of resolution (Log MAR) used to assess children aged 5-15 years. All children had cycloplegic refraction. The results of RESC show prevalence of presenting visual impairment (PVI) from 1.2% to 14.7%5. The proportion of children whose vision could be improved with refractive correction to 20/32 or better ranged around 0.9% in South Africa and over 9% in China. Recent studies on corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A light in children with keratoconus proved it to be safe and effective. In this study patients were followed up for 3 years. However corneal refractive surgery is mainly done at 18 years and later but in last few years a number of studies with small number of cases have been published on its use in paediatric cases. There is also the role of corneal refractive surgery in children with neurobehavioral problems. Young children going for PRK, LASIK or LASEK will need general anesthesia and obviously will not fixate. Anisometropia if significant is a major risk factor for refractive amblyopia. Children with severe anisometropia usually are intolerant to glasses due to anisokonia. In general anisomyopia of more than 2 D, anisohyperopia of more than1 D and anisoastigmatism of more than 1.5 D is amblyogenic8,9. Uncorrected anisomyopia of more than 6.0 D or anisohyperopia of more than 4.0 D causes amblyopia in 100% of the cases. In these cases corneal refractive surgery is a very useful treatment option. Yin and associates reported the use of LASEK in 32 children ranging in age from 6 to 14 years11. Mean preoperative SD was −10.1 D (range, −15.8 to −5.4 D). After a follow-up of 36 months, mean postoperative SD was −2.2 ± 1.0 D. Mean BCVA improved from 20/50 to 20/33. The proportion of patients who had stereopsis increased from 19% to 73%. Grade 0.5 haze was present in 6 eyes in the immediate postoperative period all of which disappeared 6 months after the procedure.(Truncated)

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