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[Intraocular pressure measurement in children]
1Département Glaucome, Clinique Sourdille, 3, place Anatole France, 44000 Nantes, France. hbressondumont@free.fr
Insights
Measuring intraocular pressure (IOP) in children is challenging due to compliance issues. Established normal pediatric IOP ranges are needed, considering various measurement techniques and age-related trends for accurate glaucoma diagnosis.
Area of Science:
- Ophthalmology
- Pediatric eye care
Context:
- Intraocular pressure (IOP) measurement in children presents unique challenges.
- Limited established normal IOP ranges for pediatric populations exist due to variable study conditions and instrumentation.
- Non-contact tonometry can be unreliable in children, while contact methods pose compliance difficulties.
Purpose:
- To review the challenges and current understanding of intraocular pressure measurement in children.
- To discuss the variability in normal pediatric IOP and factors influencing measurements.
- To highlight the importance of accurate IOP assessment for diagnosing pediatric glaucoma.
Summary:
- Pediatric IOP measurement is difficult due to non-compliance; normal ranges are not well-established.
- Perkins applanation tonometer shows mean IOP under 8 mmHg before 3 months and under 12 mmHg between 6-9 months, increasing ~1 mmHg/year until age 12.
- A proposed formula for normal pediatric IOP is To=0.71 x age (years) +10 up to age 10, approaching adult levels by age 12.
- Pediatric glaucoma (congenital, juvenile, secondary) is rare but requires confirmed hypertony via multiple methods, central corneal thickness, and clinical examination.
Impact:
- Provides a foundation for understanding pediatric IOP measurement challenges.
- Informs the development of more reliable IOP assessment methods for children.
- Aids clinicians in interpreting IOP readings and diagnosing pediatric glaucoma accurately.
Abstract:
Intraocular pressure (IOP) measurement in children is often difficult to perform because younger children are non-compliant and resisting the examination. Normal IOP in children is not well established yet because in the studies reporting about IOP, the instruments used and clinical conditions have varied. Non contact tonometer often overestimates IOP in blinking children and is not always reliable. But all the others measurement techniques use contact (GAT, Perkins, Tono-Pen, ORA, RBT), and are not always suitable and easy-touse. Under general anaesthesia, mean IOP measured with Perkins applanation tonometer is under 8 mmHg before age of 3 months and under 12 mmHg between ages of 6 and 9 months. After, IOP shows an increasing trend with age of 1 mmHg per year up to 12 years. Some studies have proposed as normal pediatric IOP: To=0.71 x age (years) +10, up to age 10. Then, IOP tends to approach adult levels by 12 years of age. However pediatric glaucoma is rare: congenital glaucoma, before age of 3 years, autosomal dominant juvenile glaucoma, with family history of glaucoma and elevated IOP, or secondary glaucoma with special context. Thus, hypertony has to be confirmed by another measurement technique, correlated to central corneal thickness, and clinical examination (optic nerve head and visual field).
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