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Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential
Published on: May 25, 2020
Visual acuity outcomes in pediatric glaucomas
Monica R Khitri1, Monte D Mills, Gui-Shuang Ying
1Department of Ophthalmology, Children's Hospital of Philadelphia, Scheie Eye Institute, Philadelphia, Pennsylvania, USA. monica.ralli@gmail.com
Insights
Pediatric glaucoma patients show better visual acuity prognosis than previously thought. Primary congenital glaucoma offers the best outlook, but factors like unilateral disease and multiple surgeries increase vision loss risk.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Glaucoma Research
Background:
- Pediatric glaucoma encompasses various subtypes, each with unique visual acuity prognoses.
- Understanding risk factors for vision loss is crucial for effective management.
Purpose of the Study:
- To compare visual acuity outcomes across pediatric glaucoma subtypes.
- To identify risk factors associated with vision impairment in pediatric glaucoma.
Main Methods:
- Retrospective review of 133 eyes from 88 pediatric glaucoma patients (2000-2010).
- Analysis of visual acuities, surgical history, glaucoma subtype, and etiology of vision impairment.
- Univariate and multivariate analyses to determine risk factors for visual impairment.
Main Results:
- 46.6% of eyes achieved excellent visual acuity (≥20/70) at a median 5-year follow-up.
- Primary congenital glaucoma showed the best prognosis (69.4% excellent acuity).
- Unilateral disease, multiple surgeries, poor initial vision, and comorbidities were linked to visual impairment (<20/200). Amblyopia was the primary cause (54.9%).
Conclusions:
- Pediatric glaucoma patients have a more favorable visual acuity prognosis than previously reported.
- Primary congenital glaucoma demonstrates a better visual outcome compared to other subtypes.
- Identifying risk factors aids in optimizing clinical management and patient counseling for pediatric glaucoma.
Purpose:
To evaluate and compare the visual acuity prognosis in the various pediatric glaucoma subtypes and to determine risk factors for vision loss.
Methods:
The medical records of pediatric glaucoma patients from 2000 to 2010 at Children's Hospital of Philadelphia were retrospectively reviewed. Visual acuities, surgeries, glaucoma subtype, and etiology of vision impairment were recorded. Univariate and multivariate analyses were performed to determine the risk factors for visual impairment.
Results:
A total of 133 eyes (36.8% primary congenital glaucoma, 28.6% aphakic glaucoma, 12.0% glaucoma associated with anterior segment dysgenesis, 12.0% Sturge-Weber glaucoma) of 88 patients were included. At last follow-up (median length, 5 years), 46.6% eyes achieved excellent (≥20/70) visual acuity. Of the glaucoma subtypes, primary congenital glaucoma conferred the best visual prognosis, with 69.4% eyes with excellent (≥20/70) visual acuity at final follow-up. Factors most associated with visual impairment (<20/200) were unilateral disease, multiple surgeries, poor vision at diagnosis, and other ocular comorbidities. The most common primary etiology for vision impairment was amblyopia (54.9%).
Conclusions:
Patients with glaucoma early in life appear to have a better visual acuity prognosis than previously reported, with those with primary congenital glaucoma faring better than other glaucoma subtypes. Recognition of risk factors for visual impairment can better guide clinical management and counseling of patients.
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