Perspectives on GlaucomaPerspective

Researchers find early predictors of long-term outcomes in childhood glaucoma

Early findings can predict long-term IOP control and visual acuity outcomes in primary and secondary childhood glaucoma and provide the data for a severity staging system, according to a study.

A group of researchers at the Bascom Palmer Eye Institute investigated the clinical factors potentially associated with poor long-term outcomes in a cohort of 15 children younger than 3 years who presented to the institute over 20 years, from 1990 top 2010. Data were collected at the initial visit, the following two visits, at 3 and 5 years, and at the most recent visit.

Three variables at the third visit, 7 months on average after presentation, already showed significant association with final LogMAR visual acuity, approximately 11 years later. They were anterior segment dysgenesis, nystagmus and previous failed angle surgery. Two additional variables showed significance at the 3-year visit, namely, failed amblyopia therapy and media opacity.

Worse final IOP control was significantly associated with the presence of media opacities and with failed angle surgery at 3 years.

The authors noted that a history of failed angle surgery may be an indirect marker for abnormality of the outflow apparatus beyond the trabecular meshwork. On the other hand, the association between media opacity and worse final IOP control suggests either a more severe disease phenotype, with extensive corneal damage, or the negative effect of surgical procedures such as cataract extraction or corneal transplantation on the long-term efficacy of glaucoma surgeries.

“In our effort to establish a severity staging system for childhood glaucoma, we will collaborate with international tertiary childhood glaucoma centers and modify our analysis for a better modeling of early risk factors,” the authors concluded. – by Michela Cimberle

Disclosure: The authors reported no relevant financial disclosures.

Early findings can predict long-term IOP control and visual acuity outcomes in primary and secondary childhood glaucoma and provide the data for a severity staging system, according to a study.

A group of researchers at the Bascom Palmer Eye Institute investigated the clinical factors potentially associated with poor long-term outcomes in a cohort of 15 children younger than 3 years who presented to the institute over 20 years, from 1990 top 2010. Data were collected at the initial visit, the following two visits, at 3 and 5 years, and at the most recent visit.

Three variables at the third visit, 7 months on average after presentation, already showed significant association with final LogMAR visual acuity, approximately 11 years later. They were anterior segment dysgenesis, nystagmus and previous failed angle surgery. Two additional variables showed significance at the 3-year visit, namely, failed amblyopia therapy and media opacity.

Worse final IOP control was significantly associated with the presence of media opacities and with failed angle surgery at 3 years.

The authors noted that a history of failed angle surgery may be an indirect marker for abnormality of the outflow apparatus beyond the trabecular meshwork. On the other hand, the association between media opacity and worse final IOP control suggests either a more severe disease phenotype, with extensive corneal damage, or the negative effect of surgical procedures such as cataract extraction or corneal transplantation on the long-term efficacy of glaucoma surgeries.

“In our effort to establish a severity staging system for childhood glaucoma, we will collaborate with international tertiary childhood glaucoma centers and modify our analysis for a better modeling of early risk factors,” the authors concluded. – by Michela Cimberle

Disclosure: The authors reported no relevant financial disclosures.

    Perspective
    Mark Eltis

    Mark Eltis

    A data-based staging system for childhood glaucoma does not currently exist but would obviously be beneficial. Chang and colleagues indicate that early findings can predict long-term visual acuity and IOP control outcomes in youngsters.

     This study suggests that in children with glaucoma, poor final IOP control was associated with the presence of media opacities and failed angle surgery. Factors associated with poor final visual acuity were anterior segment dysgenesis, nystagmus and failed amblyopia therapy. 

    While some of us manage such complex pediatric cases, it is a reminder to us all to remain vigilant regarding disease detection in children. This can be better achieved utilizing the technology at our disposal to screen IOP and carefully evaluate the nerves of younger patients. Existing alternatives to Goldmann tonometry and noncontact tonometry (as well as fundus imaging) should be employed as young as possible. The association of failed vision therapy with poor final visual acuity in young glaucoma patients reaffirms a critical role for optometry in preventing vision loss. It also opens the possibility of a highly specialized optometric practice with both pediatric glaucoma and binocular vision services working in concert. 

    • Mark Eltis, OD, FAAO
    • Lecturer, University of Waterloo
      Private practice, Toronto
      Member, Optometric Glaucoma Society

    Disclosures: Eltis reports no relevant financial disclosures.