Childhood Glaucoma Not Primarily Responsible for Poor Visual Acuity

Amblyopia and other ocular abnormalities are more likely to cause poor vision in children with glaucoma than inadequate intraocular pressure (IOP) control, according to research published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus.

Researchers included children with a diagnosis of glaucoma between 2014 and 2019 (N=246, mean age 4.55±5.20 years, 51% boys) in the analysis. They reviewed etiological trends, courses of treatment, and clinical outcomes among participants. Overall, researchers noted that glaucoma following cataract surgery (GFCS) (36.5%) and primary congenital glaucoma (PCG) (29.0%) were the most common types of glaucoma among the cohort.

Children with PCG presented at a younger age (mean age 0.75 years) than those with GFCS (mean age 5.06 years) or juvenile open-angle glaucoma (JOAG) (mean age 9.76 years).

Most patients presented with elevated IOP (69.7%). At the final follow-up, most children were taking at least 1 glaucoma medication (69.0%) and successful IOP control (IOP ≤21 mmHg) was achieved in 80.4% of participants. Among those who attained satisfactory IOP control, 31.0% did so without medication.

In bilateral and unilateral cases, final best corrected visual acuity (BCVA) was 20/40 or better among 35.61% (n=94) and 23.85% (n=26) of eyes, and 20/200 or worse in 21.59% and 48.62% of eyes, respectively.

Stratified by glaucoma type, mean BCVA was best among patients with JOAG and poorest among eyes with non acquired ocular anomalies (aniridia, anterior segment dysgenesis). In patients with GFCS, those with bilateral disease had significantly better BCVA than unilateral cases (mean 0.70 vs 1.40 logMAR; P =.0002).

Researchers determined that a final IOP of 21 mmHg or less was associated with better final BCVA (0.068 vs 0.88 logMAR; P <.001) among bilateral cases, but not among unilateral cases (1.20 vs 1.32 logMAR; P =.16).

Among eyes with poor visual acuity (worse than 20/200), 72.7% had amblyopia, which was most commonly caused by deprivation. Among eyes with deprivation, most had congenital cataract or congenital corneal opacity.

“This report highlights the negative impact that nonacquired or congenital conditions and unilateral disease have on final BCVA, and that IOP can be controlled and tends not to be the primary cause of vision loss for the vast majority of patients,” according to the investigators. “Poor vision resulted primarily from deprivational amblyopia or presence of other systemic or ocular abnormalities rather than inadequate IOP control. While childhood glaucoma remains a challenging vision threatening condition, current medical and surgical options can allow adequate IOP control in most cases, though close follow up is needed.”

This study was limited by its retrospective nature and the variability in instrumentation used to measure IOP.

Reference

Tam EK, Elhusseiny AM, Shah AS, Mantagos IS, VanderVeen DK. Etiology and outcomes of childhood glaucoma at a tertiary referral center. J AAPOS. Published online April 7, 2022. doi:10.1016/j.jaapos.2021.12.009