• <15 % of preschool children undergo a comprehensive eye examination and

• <22% receive any type of vision screening.

The American Academy of Pediatrics, the American Association of Certified Orthoptists, the American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus have issued a joint policy statement recommending that every child undergo a comprehensive vision examination before entering school, preferably between the ages of 3 and 3/12 years.

The National Eye Institute, part of the National Institutes of Health, created the Vision in Preschoolers (VIP), a multicenter clinical study designed to determine the efficacy and accuracy of preschool vision testing for amblyopia, strabismus, significant refractive error, and/or reduced visual acuity. During the first 2 study phases, approximately 4000 children received comprehensive eye examinations to test for these conditions.

The results of phases 1 and 2 indicated that >99% of children enrolled in the study were able to be successfully tested. Moreover, when the tests were used by highly skilled personnel, such as ophthalmologists trained to work with young children, approximately 66% of children within ≥1 targeted disorders were identified, as well as 90% of those children with the most serious conditions. Phase 3 is still ongoing.

In this retrospective consecutive cases series, Ghanem et al from Harvard Medical School, Massachusetts, studied outcomes in 710 eyes of 424 patients aged 40-69 years who underwent LASIK between 1999 and 2005.

The study group had refractive spherical errors ranging from -10.5 diopters (D) to +6 D and cylinder of up to 2.50 D. Patients were divided by age into 3 groups: 40-49 years, 50-59 years and 60-69 years. All LASIK procedures were performed by the same surgeon. Outcomes were analyzed for nearsightedness with or without astigmatism (511 eyes) and farsightedness with or without astigmatism (199 eyes). Outcomes were based on postoperative follow-up visits of at least 6 months.

The study indicated postoperative safety, efficacy and predictability were comparable among all age groups. At the final follow-up, 80-100% of eyes in all groups had 20/30 or better uncorrected visual acuity and 81-90% were within ±1 D. In all 3 groups, 91-100% of patients achieved 20/40 or better visual acuity following LASIK.

Many LASIK patients in the study opted for monovision, a strategy that offers distinct advantages in addressing presbyopia, a condition often present in an older population. In monovision, one eye is corrected for distance vision, while the other eye is corrected for near vision, often eliminating the need for reading glasses. Researchers indicated that monovision can effectively compensate for the loss of accommodation that often occurs in older patients. The study concluded that despite challenges unique in the 40- to 69-year age group, LASIK correction for nearsightedness and farsightedness has reasonable safety, efficacy and predictability.

Ghanem RC, de la Cruz J, Tobaigy FM, et al. LASIK in the presbyopic age group: safety, efficacy, and predictability in 40- to 69-year-old patients. Ophthalmology 2007; 114:1303-1310.

Characterized by an irregular curvature of the cornea, astigmatism can be detected by regular eye examinations and successfully treated using procedures such as laser in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), laser thermokeratoplasy (LTK) and astigmatic keratotomy (AK; Table 1). An ophthalmologist can determine which type of procedure will work best for each patient.

Worldwide, >17 million people have undergone laser refractive surgery, and refractive surgery is one of the most commonly performed operations in the United States. The newest laser-assisted procedures are approved by the U.S. Food and Drug Administration to treat up to 6 diopters (D) of astigmatism correction, which includes roughly 98% of all astigmatism patients. Advances in laser technology continue to improve treatment outcomes.

Guttman reported on a recent study by Barraquer, a private practitioner in Colombia, of 364 astigmatic myopic patients treated with a new generation “flying spot” excimer laser. Barraquer reported postoperative best-corrected visual acuity of 20/20 or better in 99% of treated eyes at 3 months. Astigmatic correction was achieved to within ±0.50 D in 92% of eyes.

Regular eye examinations can detect the presence of astigmatism and treat it in its early stages. Because children may also have astigmatism, it is important that eye examinations be scheduled at regular intervals to detect any astigmatism early on.

Guttman C. Laser yields safe, predictable correction for astigmatism. Ophthalmology Times, Advanstar Communications, January 1, 2008;36.