Clinical Course and Predictors of Glaucoma Conversion in Pediatric Ocular Hypertension without Ocular or Systemic...

To characterize the long-term clinical course of pediatric ocular hypertension in patients without associated ocular or systemic risk factors and identify predictors of glaucoma conversion.

Retrospective cohort study.

Pediatric patients evaluated as glaucoma suspects for ocular hypertension at the Johns Hopkins Wilmer Eye Institute between January 1, 2005, and June 1, 2024.

Medical records of pediatric glaucoma suspects were reviewed. Eligible eyes were from patients aged <18 years with intraocular pressure (IOP) > 21 mmHg on at least 2 encounters, ≥180 days of follow up, and no ocular or systemic glaucoma-associated risk factors. Multivariable logistic regression identified predictors of conversion.

Primary outcome was conversion to glaucoma based on Childhood Glaucoma Research Network criteria or glaucoma-related surgical intervention. Secondary outcomes included IOP-lowering treatment use and final IOP status.

Among 1390 eyes screened, 449 eyes from 247 patients met inclusion criteria. Mean follow up was 7.1 ± 4.9 years. During follow up, 39 eyes (8.7%) converted to glaucoma. Compared with nonconverters, converter eyes had higher baseline IOP (28.53 ± 12.25 vs. 24.32 ± 4.76 mmHg, P < 0.001), larger cup-to-disc ratio (CDR) (0.59 ± 0.22 vs. 0.43 ± 0.23, P < 0.001), and were more frequently male (61.5% vs. 41.1%, P = 0.014). In multivariable analysis, male sex (adjusted odds ratio [aOR]: 3.19; P = 0.006), higher baseline IOP (aOR: 1.12 per mmHg, P = 0.001), larger baseline CDR (aOR: 1.32 per 0.1 increase, P = 0.001), Goldmann applanation (aOR: 3.17, P = 0.010), and Tono-Pen tonometry (aOR: 5.48, P = 0.013) were associated with conversion. Among converters, treatment initiation was more common (92.3% vs. 23.2%, P < 0.001), while treatment discontinuation was less common (8.3% vs. 30.4%, P = 0.009). At final follow up, all converted eyes achieved normalized IOP, although 92.3% required ongoing treatment. Among nonconverters, 50.7% achieved normalized IOP at the final follow up (76.9% without treatment and 23.1% with treatment).

Isolated pediatric ocular hypertension is not uniformly benign and carries a measurable long-term risk of glaucoma conversion. Higher baseline IOP, larger CDR, and male sex were associated with progression and may assist in early risk stratification. These findings support individualized surveillance and treatment strategies, with closer monitoring and earlier therapeutic consideration for children with higher-risk baseline features.

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