StemCell Therapy

Michael Chaglasian, OD, FAAO, is chief of staff at the Illionois Eye Institute

Stacy Potwin, OD, FAAO, is a staff optometrist at the Veterans Affairs community-based outreach clinic in Charleston, WV

Abstract / Synopsis:

Children are not just miniature adults, and a variety of factors need to be considered when diagnosing and treating pediatric glaucoma patients.

Many of the questions ODs have about adults with glaucoma suspicion are the same for children: Who will go on to develop glaucoma, and why do some children respond well to treatment and others do not?

In many ways, pediatric glaucoma has completely different concerns than adult glaucoma: Children have their whole lives to lose vision from glaucoma, the treatment has numerous years to cause side effects, and many pediatric glaucoma patients will require significantly more surgeries than adults with glaucoma.

Pediatric glaucoma can become aggressive very quickly. Children can lose vision from the glaucoma itself but, unlike adults, can have permanent vision loss from amblyopia and corneal scarring that occur before treatment. Treating an infant, child or adolescent with glaucoma requires a team approach, and optometrists have an important role to play.

Related:Know what common glaucoma mistakes to avoid

Childhood blindness occurs in 0.03 percent of children in high income countries and up to 0.12 percent in undeveloped countries worldwide. Glaucoma accounts for 4.2 to 5 percent of childhood blindness. The main cause of vision impairment in children with glaucoma is amblyopia.1

Primary congenital glaucomaAccounting for 50 to 70 percent of childhood glaucoma, primary congenital glaucoma (PCG) is the most common form.

PCG is diagnosed from birth to early childhood (80 percent in the first year of life). There is reduced aqueous outflow through an abnormally developed filtration angle/trabecular meshwork, which begins to form in the fourth gestational month and reaches adult structure by age 8.1-3 PCG has an autosomal recessive inheritance.4 It is bilateral 70 to 75 percent of the time, and can be asymmetric.1,4

Early diagnosis is imperative because PCG can be aggressive, and children can lose vision quickly. Interestingly, if treatment is successfully performed early enough, glaucomatous cupping can actually be reversed, owing to the immature, elastic lamina cribrosa.1,2,4,5

Related: Glaucoma facts: Essential perspectives for long-term management

References:

1. Marchini G, Toscani M, Chemello F. Pediatric glaucoma: current perspectives. Pediatric Health Med Ther. 2014;5:15-27.2. Karmel M. Childhood glaucoma. EyeNet Magazine. Available at: https://www.aao.org/eyenet/article/childhood-glaucoma?august-2016. Accessed 5/20/20.3. Karmel M. Caring for children with congenital glaucoma. EyeNet Magazine. Available at: https://www.aao.org/eyenet/article/caring-children-with-congenital-glauc.... Accessed 5/20/20.4. Freedman S. Managing pediatric patients with glaucoma. Review Ophthal. 2016 May 10;23(5):80-84.5. Freedman SF. Pediatric glaucoma. Glaucoma Today. 2006 Jul/Aug:25-28.6. Ho CL, Walton DS. Primary congenital glaucoma: 2004 update. J Pediatr Ophthalmol Strabismus. 2004 Sep-Oct;41(5):271-288.7. Do A, Panarelli JF. Pediatric MIGS. Glaucoma Today. 2017 Mar/Apr:48-49.8. Chang TCP. MIGS in kids. Glaucoma Today. 2016 Sept/Oct:54-56.9. Huang W. Pediatric glaucoma: A review of the basics. Rev Ophthalmol. 2014 April;21(4):76-80.10. Giangiacomo A, Beck A. Pediatric glaucoma: review of recent literature. Curr Opin Ophthal. 2017 Mar;28(2):199-203.11. Beck A. Evaluating and managing optic disc cupping in children. Glaucoma Today. 2009 Jan/Feb:26-28.12. Bar-Sela SM, Feldman RM. Diagnosing and managing ocular hypertension in teenagers. Glaucoma Today. 2009 Jan/Feb:29-32.13. Chak G, Mosaed S, Minckler DS. Diagnosing and managing juvenile open-angle glaucoma. EyeNet Magazine. Available at: https://www.aao.org/eyenet/article/diagnosing-managing-juvenile-openangl.... Accessed 5/20/20.14. Black AC, Jones S, Yanovitch TL, Enyedi LB, Stinnett SS, Freedman SF. Latanoprost in pediatric glaucoma--pediatric exposure over a decade. J AAPOS. 2009 Dec;13(6):558-562.15. Nuyen B, Weinreb RN, Robbins SL. Steroid-induced glaucoma in the pediatric population. J AAPOS. 2017 Feb;21(1):1-6.16. Stuart A. The challenge of diagnosing pediatric glaucoma. EyeNet Magazine. 2009 Nov/Dec. Available at: https://www.aao.org/eyenet/article/challenge-of-diagnosing-pediatric-gla.... Accessed 5/20/20.17. Greenberg MB, Osigian CJ, Cavuoto KM, Chang TC. Clinical management of outcomes of childhood glaucoma suspects. PLoS ONE. 2017 Sep;12(9):e0185546.18. Walton DS. Managing the pediatric glaucomas. Glaucoma Today. 2009 Jan/Feb:21-24.

Original post:
Pediatric glaucoma: types, tests and treatments - Optometry Times

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