Ophthalmologist and Physician-Scientist
Pediatric Glaucoma and the Critical Importance of Early Detection

Pediatric Glaucoma and the Critical Importance of Early Detection

One of the important facts often overlooked about glaucoma is the fact that the disease can also affect children. Glaucoma is often thought of as a disease affecting seniors since it primarily affects older people. In rare cases, the condition can also affect children. The mechanism is the same in both populations: intraocular pressure builds as the fluid that normally flows out of the eye fails to drain correctly. The pressure causes damage to the optic nerve, which transmits visual messages from the retina to vision centers in the brain. Physicians do not currently have the tools to restore vision once it has been lost, which is why detecting the disease in children early on is critical. A failure to do so can result in the permanent loss of vision.

In children, glaucoma is often mistaken for other conditions. The other complicating factor is children do not always have the capacity to describe what is happening to them. In general, parents should ensure that a pediatrician examines a child’s eyes regularly and then follow up with a specialist immediately if childhood glaucoma is suspected. The typical recommendation is for children to have their eyes examined in their first year of life followed by a comprehensive eye exam before they turn 4-years-old. Of course, if any other issues become apparent before that time, parents should speak to a pediatrician as soon as possible. Catching the disease early on could mean the difference between full or partial vision for the remainder of a child’s life.


The Epidemiology and Presentation of Glaucoma in Children

Among children, glaucoma can be either primary or secondary. Primary glaucoma is typically congenital in nature and results from the abnormal development of the ocular drainage system. About 10 percent of cases of congenital glaucoma are present at birth, and an additional 80 percent of cases will become apparent within the first year of life. This occurs in about one out of every 10,000 births in the United States. Even at this low rate, congenital glaucoma is still the most common form of the disease. Secondary glaucoma is a result of other disorders of either the body or the eye, which themselves can be either genetic or acquired. Several different diseases processes can lead to secondary glaucoma, such as uveitis. In addition, procedures such as surgery for congenital cataracts can result in pediatric glaucoma.

Glaucoma in children can present in a number of different ways, which is why the disease is often misdiagnosed. Furthermore, the symptoms are often not as obvious as they are in adults. Some things parents should look out for include a sensitivity to light (whether in one or both eyes), as well as an enlarged and cloudy cornea. Excessive tears and one eye being larger than the other, as well as enlarged eyes, may also point to a potential disease process. Younger children may simply be fussy, show signs of pain or begin to eat poorly. As soon as parents notice any of these issues, they should consult with a pediatrician, as glaucoma and several other serious conditions may be present.

The Treatment and Prognosis for Children with Glaucoma

Often, pediatric glaucoma is treated in a different way than the adult variants. Among adults, pharmacologic agents are often the first line of treatment with surgery only becoming necessary when these drugs fail. For children, surgery is often required and undertaken soon after the disease is identified. Surgery can reduce intraocular pressure by increasing fluid outflow from the eye or inhibiting the initial production of this fluid. For example, surgeons may perform a goniotomy, which involves making a hole through the trabecular meshwork, an anatomic drain that exists in the eye. This is accomplished through a minimally invasive technique. The rate of success of these surgeries are often linked to the age of the child at the time of diagnosis, as well as the type and severity of the disease. Other surgical options exist that are more akin to adult variants, such as trabeculectomy and drainage tube placement.

Prompt surgical treatment results in good outcomes in about 80-to-90 percent of cases, particularly when the children continue to be monitored and receive long-term care. Most of these children will have normal vision for the remainder of their lives. Unfortunately, some children do experience severe visual impairment even after surgery. Primary congenital glaucoma results in blindness in about 2-to-15 percent of patients. They are usually children in whom the condition is not recognized and addressed early. A delay in diagnosis results in a significantly increased risk of permanent blindness. Even among those children who do experience some vision loss as a result of pediatric glaucoma, some steps can be taken to help optimize their vision, enabling them to continue to lead fulfilling lives without significant impairment.