Monitor pediatric glaucoma suspects with risk factors for disease progression closely. This photo shows an infant with buphthalmos OD due to congenital glaucoma. Photo: Michalgoback, CC via Wikimedia Commons. Click image to enlarge.

In an attempt to describe the rate of disease development in a large cohort of pediatric glaucoma suspects with ocular hypertension, researchers recently found that these eyes had higher rates of progression to glaucoma than eyes being monitored for prior lensectomy, other ocular risk factors, suspicious disc appearance or systemic risk factors.

The retrospective case series included 1,375 eyes (824 individuals) followed as pediatric glaucoma suspects at the Wilmer Eye Institute between 2005 and 2016.

A total of 11.5% of eyes met criteria for conversion to glaucoma during follow-up, with rates of conversion reported to be 34.1% for eyes monitored for ocular hypertension, 16.2% for eyes with prior lensectomy, 12.1% for eyes monitored for other ocular risk factors, 2.4% for eyes with suspicious disc appearance and 0.4% for eyes monitored for systemic risk factors. Criteria were ocular hypertension (94.3%), enlargement of cup-to-disc ratio since initial presentation (28.5%), surgical intervention (20.9%), visual field changes (13.3%), asymmetric cup-to-disc ratio change compared with fellow eye (12.7%) and enlarged cup-to-disc ratio (5.7%).

Eyes being monitored for ocular hypertension had an 18-fold increased risk of conversion to glaucoma than those followed for suspicious disc appearance. Eyes monitored for prior lensectomy and for other ocular risk factors had a six-fold and five-fold increased risk of conversion to glaucoma than those followed for suspicious disc appearance, respectively. Eyes followed for ocular hypertension were nearly four-times more likely to convert to glaucoma than those followed for prior lensectomy.

“In comparing the rates of conversion to glaucoma among pediatric glaucoma suspects being followed as glaucoma suspects for a variety of risk factors and associations, the findings from this study underlie the importance of close outpatient screening and monitoring of pediatric glaucoma suspects, especially with quantitative and qualitative imaging and testing modalities, including visual fields and OCT, especially in those groups that are at higher risk of conversion to glaucoma.”