Higher Baseline IOP, Periocular Lesions Predict Risk of Glaucoma Conversion in Children

Children who are glaucoma suspects and have a higher baseline IOP or periocular lesion are at increased risk of conversion to glaucoma.

Children have a low risk of conversion from glaucoma suspect status to a glaucoma diagnosis, according to a study published in Journal of AAPOS. But children with a baseline intraocular pressure (IOP) higher than 24 mm Hg and periocular lesions are at a higher risk.

Researchers retrospectively analyzed data from 887 children (mean [SD] age, 9.3 [4.7] years; 55% boys; 42% Black) who were glaucoma suspects, according to clinical criteria, due to optic nerve appearance (83%), family history (25%), ocular hypertension (15%), periocular lesion (4%), blunt-trauma history (3%), ocular anomaly (2%) or systemic or genetic syndrome (1.5%). Diagnostic tests included optical coherence tomography (OCT) imaging of the retinal nerve fiber layer (RNFL) in 458 (52%) children, visual fields in 166 (19%) patients and gonioscopy in 23 (3%) participants.

A total of 487 participants had at least 1 follow-up visit over a mean [SD] 1.7 [1.6] years. Among these children, 14 (3%) converted to a glaucoma diagnosis while 324 (67%) remained as glaucoma suspects. A total of 116 (29%) who did not attend any follow-up visits were suspected to have physiologic or pseudo glaucomatous cupping.

[C]hildren with a periocular lesion or higher baseline IOP are at higher risk of progressing to glaucoma.

A total of 773 children met Childhood Glaucoma Research Network criteria for glaucoma suspect status which included an IOP higher than 21 mm Hg on 2 separate occasions, suspicious optic disc appearance, suspicious visual field, or increased corneal diameter or axial length with normal IOP. The report shows similar findings compared with children diagnosed according to clinical criteria. 

According to the report, cup-to-disk ratio and family history of glaucoma were not predictive of glaucoma, while patients with periocular lesions and IOP above 24 mm Hg carried a higher risk. 

”[T]he risk of conversion of pediatric [glaucoma suspect] to glaucoma diagnosis appears low,” according to the researchers. “There are currently no evidence-based or consensus practice patterns for pediatric glaucoma suspects. Based on our study results, children with a periocular lesion or higher baseline IOP are at higher risk of progressing to glaucoma.”

Study limitations include potential inherent referral bias due to the institutional setting and variability in measurements and clinicians performing the measurements.


Kletke SN, Mills MD, Tomlinson LA, Yu Y, Ying G-s, Binenbaum G. Pediatric glaucoma suspects: characteristics and outcomes. J AAPOS. Published online September 13, 2022. doi:10.1016/j.jaapos.2022.05.010