Dear Editor

The authors report on LASIK surgery in five children with unilateral high myopia who were presumed to have amblyopia. One subject had bilateral high myopia.

Optic nerve hypoplasia is associated with high myopia. In addition, anisometropic myopia is a common sequela of retinopathy of prematurity. Thinning of the sclera with posterior staphyloma formation has long been known to be associated with high myopia. Best corrected visual acuity in these patients is often limited by associated retinal and scleral pathology.

None of the treated eyes obtained acuity better than 6/15. This limited outcome following refractive surgery may only be due to optical enlargement of the retinal image rather than enhanced neurosensory function. In the 3 children who were less than 3 years old improved literacy, familiarity with the test procedure, and the Hawthorn Effect, were certainly important factors in their assumed improvement. The absolute lack of progress in one child was a likely manifestation of pre- existing retinal pathology rather than non-compliance with patching.

The authors advocate increased use of LASIK to thin the corneas of highly myopic children who already have profound reductions in scleral thickness. “From a clinical viewpoint, optic nerve hypoplasia should be carefully looked for in all patients with unilateral bilateral high myopia and visual loss.”[1] It may well be more appropriate to improve the quality of retinal and optic nerve evaluations prior to performing irreversible surgical procedures with unknown long term consequences for these abnormal eyes.

References

(1) M O’Keefe and L Nolan LASIK surgery in children Br J Ophthalmol 2004; 88: 19-21.

(2) Avery H. Weiss and Eric A. ROS Axial myopia in eyes with optic nerve hypoplasia Graefe's Arch Clin Exp Ophthalmol (1992) 230:372-377

(3) McBrien NA, Gentle A. Role of the sclera in the development and pathological complication of myopia. Progress in Retinal and Eye Research 22 (2003):307-338

(4) Wickstrom G, Bendix T. "Hawthorne effect"--what did the original Hawthorne studies actually show? Scand J Work Environ Health. 2000 Aug;26(4):363-7

(5) Lied TR, Kazandjian VA.A Hawthorne strategy: implications for performance measurement and improvement. Clin Perform Qual Health Care. 1998 Oct-Dec;6(4):201-4.