LASIK in an 11-Year-Old Child
An 11-year-old should not undergo LASIK surgery, as age under 21 years is a relative contraindication according to the American Academy of Ophthalmology, and FDA labeling for each laser platform should be consulted for specific age restrictions. 1
Age-Related Contraindications
- Age under 21 years is explicitly listed as a relative contraindication in the 2023 Refractive Surgery Preferred Practice Pattern from the American Academy of Ophthalmology 1
- The primary concern is unstable refraction, which is an absolute contraindication to LASIK 1
- Children and adolescents typically experience ongoing refractive changes as their eyes continue to grow and develop, making them poor candidates for permanent corneal reshaping 1
Regulatory and Safety Framework
- FDA labeling for each specific laser platform must be consulted for age-specific indications, as different devices may have varying age restrictions 1
- The FDA has approved LASIK for correction of myopia, hyperopia, and astigmatism, but these approvals typically specify minimum age requirements that exceed 11 years 1
- Refractive stability is essential before considering any keratorefractive procedure, and this is rarely achieved before late adolescence or early adulthood 1
Limited Exceptions in Pediatric Populations
While LASIK is generally contraindicated in children, research has documented its use in highly specific circumstances:
- Unilateral high myopic or hyperopic anisometropia where conventional optical correction fails and amblyopia management is compromised 2, 3, 4
- Studies have shown LASIK can facilitate amblyopia therapy in children aged 6-14 years with severe anisometropia (>6D difference) when performed after mandatory occlusion therapy 3, 4
- A 10-year follow-up study of pediatric LASIK for myopic anisometropia showed maintained safety and stability, with no evidence of post-LASIK ectasia 4
However, these cases represent exceptional clinical scenarios where:
- The child has completed amblyopia therapy 2
- Conventional optical correction (glasses/contact lenses) has failed or is not tolerated 3, 4
- The anisometropia is severe enough to threaten normal visual development 3, 4
- The procedure is performed under topical or general anesthesia due to cooperation requirements 2, 3
Critical Considerations Against LASIK at Age 11
Refractive instability remains the most significant concern:
- Myopic shift over time has been documented in pediatric LASIK patients, with LASIK patients averaging -0.875D of myopic shift over 20 months in one study 2
- Even in adults, minimal but significant regression occurs during long-term follow-up 5
- The younger the patient, the greater the likelihood of continued refractive change requiring additional procedures 2
Informed consent challenges:
- An 11-year-old cannot provide truly informed consent for an elective, permanent surgical procedure 1
- The child must be cooperative enough to undergo the procedure with topical anesthesia, which may require general anesthesia in younger patients 2, 3
Clinical Algorithm for Decision-Making
For routine refractive errors in an 11-year-old:
- Prescribe spectacles or contact lenses as the appropriate refractive correction 1
- Defer any consideration of LASIK until at least age 21 or when refractive stability is documented for at least 1-2 years 1
- Monitor for refractive stability through serial examinations 1
For exceptional cases (severe anisometropic amblyopia):
- Ensure all conventional amblyopia therapy has been exhausted 2, 3
- Document that optical correction is failing or threatening visual development 3, 4
- Obtain comprehensive informed consent from parents/guardians with clear discussion of off-label use 1
- Perform thorough preoperative evaluation including corneal topography/tomography to rule out keratoconus or other contraindications 1
- Plan for long-term follow-up to monitor for refractive regression and potential complications 4
The standard answer for routine cases remains: No, an 11-year-old should not undergo LASIK surgery. 1