Developmental Improvement in Children With Intellectual Disability After Photorefractive Keratectomy for Severe Isoametropia

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Abstract

PURPOSE

To assess the impact of refractive error correction from photorefractive keratectomy on development in children with severe isoametropia, subnormal visual acuity, and intellectual disability unable to use refraction correction.

DESIGN

Prospective noncomparative interventional case series.

METHODS

Before and after photorefractive keratometry (PRK), subjects who had plateaued developmentally for 18 or more months were assessed using a battery of developmental tests. The primary outcome measure was the change in the developmental quotient (DQ) 6 months after PRK. Secondary outcomes were the change in the DQ, uncorrected visual acuity, cycloplegic refraction, and corneal status 12, 24, and 36 months after PRK.

RESULTS

Sixteen subjects aged 2 to 8 years were included. Twelve were highly myopic (mean, –9.69 ± 3.82 diopters [D]), 3 highly hyperopic (mean, +5.75 ± 0.59 D) and 1 highly astigmatic (mean, +3.50 D). Six months after PRK, the DQ significantly improved for expressive communication (mean, 4.51 ± 2.27 months; P = .04), interpersonal relationships (mean, 9.45 ± 4.18 months; P = .02) and coping (mean, 6.44 ± 2.10 months; P = .05). Twelve months after PRK, the DQ significantly improved for receptive communication (8.04 ± 1.80 months; P < .001), expressive communication (6.99 ± 2.27 months; P < .05), written communication (9.28 ± 3.72 months; P < .04), domestic skills (6.50 ± 2.43 months; P < .03), interpersonal relationships (10.57 ± 4.17 months; P < .02), and coping (8.41 ± 3.25 months; P < .5).

CONCLUSIONS

PRK significantly improves developmental abilities of children with intellectual disability, severe isoametropia, and previously plateaued development, in addition to improving visual acuity and refractive error.

Section snippets

Material and Methods

This prospective, noncomparative interventional case series assessed the change in the developmental quotient (DQ) of children with intellectual disability, significant isoametropia, and subnormal uncorrected vision who were unable or unwilling to use refractive correction with either contact lenses or glasses and who underwent PRK to improve their refractive error. The DQ is the ratio of the subject's developmental age divided by the subject's chronological age in months × 100. This study was

Results

A total of 16 children were included (7 females, 9 males), with ages ranging from 2 to 8 years old (mean, 5.4 ± 1.3 years). The individual and summarized demographic and ophthalmologic characteristics of the subjects are listed in Tables 1 and 2.

Discussion

This study is the first, to our knowledge, that has objectively evaluated the change in developmental abilities in refractive correction-intolerant children with severe intellectual disability and high isoametropia after PRK over a 3-year period. All of the children had plateaued in their development for at least 18 months before the PRK, which means that their DQs were decreasing up to the time of the PRK. It has previously been shown that PRK and LASEK result in a decrease in the refractive

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Supplemental Material available at AJO.com.

Dr Catherine Achim is now practicing at Centre Hospitalier Universitaire de Quebec – CHUL, 2705 boul Laurier, Quebec QC GIV 4G2, Canada. Dr Bryan Whitlow is now practicing at University of North Carolina, Department of Anesthesiology, UNC Hospitals, CB# 7010, Chapel Hill, North Carolina 27599-7010.

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