Reply: The comments by Drs. Dada and Vajpayee give us the opportunity to clarify some points. We agree with them that refractive errors in children are not stable and not all pediatric eyes are candidates for refractive surgery. In our study, LASIK was performed selectively in children with uniocular high myopia to prevent anisometropic amblyopia. The preferred mode of treatment with contact lenses is not appropriate in our country because of the socioeconomic conditions. The basic aim of preventing amblyopia is not achieved in these cases, since most cases discontinue contact lens wear.
Eyes with refractive errors of more than –15.0 D were included in this study so that post-LASIK spectacles, if required, would produce minimal anisokonia and hence aid in binocular single vision. In our study, the operative zone was reduced to 4.0 mm to obtain maximum correction in only 2 eyes. We agree with Drs. Dada and Vajpayee that a reduced ablative zone diameter is likely to produce significant glare and problems with night vision, which are secondary to obtaining maximum correction.
In these eyes, a marked regression is likely to occur beyond 12 months. We can tackle these cases by regular cycloplegic and manifest refraction and with another LASIK treatment if there is sufficient corneal thickness available. This is an accepted method of treating myopic regression.
We agree with the authors that we should avoid eyes with keratometer values less than 40.0 D to prevent free caps.
We think LASIK is a safe and effective procedure in treating unilateral pediatric high myopia to prevent anisometropic amblyopia. Further large studies and longer follow-ups are required.
Amar Agarwal MS, FRCS, FRCOphth