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Today's Practice | Apr 2010


To the Editor:

My name is Merab Dvali. I am a professor of ophthalmology and a cataract and refractive surgeon.

We are receiving your publication in Georgia, and I recently read the article “Refractive Surgery in Children: Indications and Contraindications” in Cataract and Refractive Surgery Europe (September 2009, page 42).

I am disappointed rather than surprised that almost all participants of this discussion have a negative opinion on the topic. Almost everyone was against pediatric LASIK when there are so many publications on the matter that show excellent results in cases with proper indications.

We are among the pioneers and have 10 years' experience in pediatric LASIK, and I think our opinions may have been of interest to your readers. We consider that pediatric LASIK is not indicated for all cases. As a rule, there is a little or no chance of keratoconus or elongation of the optic axis from bulging of the posterior pole in hyperopic eyes, so in these cases, pediatric LASIK is rather reasonable and expedient. On the other hand, we are in agreement that the treatment should not be more harmful than the disease.

On this basis, we are performing customized pediatric LASIK in patients ages 8 years and older, and only in cases of hyperopia and hyperopic astigmatism. We perform the procedures without general anesthesia (decreasing decentration risks). During our 10 years of experience, we have not had a significant decentration or iatrogenic ectasia.

It would be interesting if you would cover opinions of colleagues who have a lot of experience in pediatric LASIK on the pages of your comprehensive journal. There are experienced refractive surgeons worldwide who agree with the opinion that pediatric LASIK is indicated and expedient to treat or avoid refractive amblyopia. It would be interesting for ophthalmologists to read an opposite opinion.

One of the scientific sessions was dedicated to this topic at the First World Congress of Pediatric Ophthalmology and Strabismus during the XXVII Congress of the European Society of Cataract and Refractive Surgeons (ESCRS), in Barcelona, where we reported 10 years of excellent results with pediatric hyperopic LASIK.

Yours respectfully,
Merab Dvali, MD

Dear Dr. Dvali,

Thank you for taking the time to write to CRST Europe. We are delighted that our publication is reaching Georgia!

The negative commentary was related to active advertising of pediatric LASIK in a particular country where, I understand, so-called guilt trips were being laid on parents of children with refractive error. The issues, I believe, are in whom and when, and I do not believe the contributors were completely discounting pediatric LASIK altogether. Certainly, long-term outcomes are important, and it is useful to know that a 10-year follow-up is being actively pursued.

I hope we can continue this discussion in the format of letters within CRST Europe.

Thanks again for your communication.

Sheraz Daya, MD, FACP, FACS, FRCS(Ed)