Refractive surgery in the late adulthood and adolescent age groups

Purpose: Most refractive surgeries are performed in the young-adult age group, and less is known about the clinical outcomes of patients in late adulthood and of adolescents. The purpose of this study was to describe the outcomes of refractive surgery in patients over the age of 60 years and under the age of 18 years compared with a control group of patients aged 20–40 years. Methods: This retrospective cohort analysis consisted of 64,970 consecutive cases of 32,074 patients who underwent laser-assisted in situ keratomileusis and photorefractive keratectomy during a 10-year period in a single center. The populations were characterized, and a comparison of safety, efficacy, and retreatment rates was performed following propensity score matching, separately for hyperopic and myopic treatments. Results: Included in the analysis after matching were 143 patients above the age of 60, 608 patients aged < 18, and 2313 patients aged 20–40. Older patients undergoing hyperopic treatments had worse safety (0.95 ± 0.1 versus 0.99 ± 0.2, P = 0.023) and efficacy indices (0.89 ± 0.2 versus 0.97 ± 0.2, P = 0.004) compared with young adults. Lower efficacy was also seen in myopic treatments (0.88 ± 0.3 versus 0.97 ± 0.2, P = 0.001). Higher retreatment rates were also seen among older adults (6.2% versus 2.5%, P = 0.044 in hyperopic treatments, 11% versus 1.1%, P < 0.001 in myopic treatments). In adolescents, the safety and efficacy outcomes were slightly better compared with patients aged 20–40, with lower retreatment rates (1% versus 2.7%, P = 0.001). Conclusions: Refractive surgery in the late adulthood population of our cohort was a relatively safe procedure, yet manifesting lower efficacy and requiring more retreatments. In adolescents, results were comparable to those achieved in young adults.