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Sumitra khandelwal, Allen Beck; Outcomes of Pediatric Glaucoma Suspects With a Large Cup-Disc Ratio. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4470.
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To evaluate the outcomes of pediatric glaucoma suspects with a large cup-disc ratio.
A retrospective single center chart review of all pediatric patients (under 18 years of age) evaluated for an increased cup-disc ratio. Patients who were diagnosed with either glaucomatous or non-glaucomatous optic neuropathy on their initial visit were excluded from the study. Demographic data, past medical history, length of follow-up, examination data including visual acuity, intraocular pressure (IOP), pachymetry, optic nerve evaluation (imaging data and vertical cup-disc ratio), and visual field results were abstracted from the medical records.
A total of 136 patients were identified from 1998 to 2011. 24 patients did not have adequate medical record information and were excluded. Another 34 patients were excluded based on a diagnosis of glaucomatous or non-glaucomatous optic neuropathy on the first evaluation. The remaining 78 patients were divided into two groups based on length of follow up, group A (3 years or greater, n= 28) and group B (less than 3 years, n=50). No statistically significant difference was noted between the two groups for the following parameters, age at presentation (mean 9 years), refractive error (mean 1.8 diopters), IOP (mean 17 mm Hg), pachymetry (mean 555 microns), and vertical cup-disc ratio (0.65). Five patient were treated with medications prior to being taken off at first visit (average medicines 1 drop). No patient in either group was diagnosed with glaucoma defined as a reproducible visual field deficit or a clinical change in the optic nerve. Optical coherence tomography was abnormal in one patient with a history of prematurity and developmental delay.
The pediatric patient with a large symmetrical cup-disc ratio in the absence of IOP elevation has a very low risk of developing glaucoma with intermediate follow-up. Long term studies are needed to assess the life-time glaucoma risk in these patients.
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