Doctors are using implantable lenses to treat U.S. children with a lazy eye condition, to try and prevent virtual blindness.
The experimental surgery uses the lenses, the same kind that nearsighted adults can have inserted for crisper vision, but they aren’t officially approved for use in children.
Dr. Paul Dougherty performed surgery on 7-year-old Megan Garvin, and delicately slipped a tiny lens inside the right eye.
“Without this technology, we couldn’t help her,” says Dougherty, a prominent Los Angeles eye surgeon who invited The Associated Press to document Megan’s surgery. “This would be written off as a blind eye.”
Up to 5 percent of children suffer from lazy eye, also called amblyopia. The condition is found where one eye is so much stronger than the other that the brain learns to ignore the weaker eye. If left untreated, the proper neural connections for vision don’t form, eventually rendering that eye useless.
If amblopia is caught by preschool, it can be fairly easy to fix by patching over the strong eye. Doctors also suggest using special drops in it, for several hours a day so that the brain is forced to use the weak eye.
The older the child is, the less effective the treatment – and by age 9, brain-eye connections are established.
The leading cause of amblopia is eyes that aren’t perfectly aligned. But a big difference in focusing power also triggers amblyopia.
For example, the Garvin girl had near-perfect vision in one eye, but the other was too nearsighted to even see the big E on the eye chart.
The condition is tough to catch. Kids don’t often realize they’re seeing clearly out of only one eye. For Megan, the difference was a kindergarten eye exam.
“She reads perfectly, she’s a very normal active child,” says her mother, Rosie Garvin. “If she would not have had that vision test, I would never have known.”
Ophthalmologists said Megan was one of the worst cases they’d ever seen, because a solution was hard to find.
Glasses weren’t doable, because one side would have required a clear lens and the other a Coke-bottle thickness, a prescription of minus 12 diopters.
Her parents tried using a contact lens in the bad eye, but it only got her to 20-60 vision, which allowed her to see blurrily. But Megan often cried about the contact, and she had trouble keeping it in at school.
Upset, the Garvins ultimately opted for the implant – and days later, are feeling hopeful. Megan says she can see out of her right eye, and is complaining at the required week of rest to let the tiny incisions in her eye heal.
There is a long road ahead. Months of patching lie ahead to try to reverse the lazy eye, or the brain would just stick with the connections it has already formed to her strong eye. Dougherty did not make any promises.
“I know we’ve got our work ahead of us,” says Rosie Garvin, from Simi Valley, Calif. “I’m so relieved … and going to make sure I do everything they tell me to make sure this works for her for life.”
Implantable lenses for adults, called phakic intraocular lenses or IOLs, were made available in the U.S. market in 2004.
These lenses are placed on top of a natural lens that can’t focus properly and help sharpen vision, unlike cataract surgery that requires removal of the eye’s natural lens because it is clouded.
Implantable lenses do come with risks including surgical infection, inflammation, and a potential for cataracts to form. It costs about $4,000 an eye, which is more expensive than the controversial laser eye surgery LASIK. However, the lenses can be removed if there are problems.
But, “how this lens is going to work in a child’s eye, we don’t know. We’ve never done studies,” cautions Dr. Punin Shah, a cornea specialist at Ochsner Medical Center in New Orleans.
Experimentally speaking, it is legal to implant the lenses in a child. In fact, a handful of medical journal reports show surgeons are starting to try the approach for amblyopia.
The French studied 12 children, and found all had improved vision after the surgery and half recovered normal binocular vision.
Other surgeons are experimenting with LASIK in children like Megan.
Dr. Michael Repka, a pediatric ophthalmologist at Baltimore’s Johns Hopkins University, says both approaches are in their early stages.
“It’s an exciting thing in a patient who has had conventional therapy and failed,” says Repka, a spokesman for the American Academy of Ophthalmology. His research shows it best, stay tuned: Repka’s own research shows it can be possible to treat after age 9, long the cut-off, and he is to publish details soon.
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