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O’Keefe and Nolan report on LASIK surgery in five children with unilateral high myopia who were presumed to have amblyopia.1 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 be because optical enlargement of the retinal image rather than enhanced neurosensory function. In the three 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 probable manifestation of pre-existing retinal pathology rather than non-compliance with patching.2–5
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 before performing irreversible surgical procedures with unknown long term consequences for these abnormal eyes.