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Sylvia Linner Groth, Kristin Crosnoe, William Eric Sponsel; Visual field change in pediatric patients after receiving laser peripheral iridotomy for intermittent angle closure glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5610.
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© ARVO (1962-2015); The Authors (2016-present)
Pediatric patients with intermittent angle closure glaucoma (IACG) are typically identified with recurrent frontal headache and corresponding gonioscopic findings, often with clinically normal intraocular pressure (IOP). Children often have problems undergoing standard perimetric testing, but are generally adept at frequency doubling technology (FDT) visual field testing that can confirm the diagnosis and provide clinical basis for treatment. We performed a retrospective, case control clinical study to evaluate the change in FDT mean deviation (MD) in pediatric patients after Nd:YAG laser peripheral iridotomy (LPI) for IACG.
This study looked at all subjects < 18 years with the diagnosis of IACG undergoing LPI from 2010 to 2015 at a single clinical site with pre- and post-laser FDTs. Change in MD on FDT from pre-laser to post-laser was primary outcome. Post-laser field was selected as the closest to 12 months after treatment. IOP was secondary outcome. An age-matched control group of concurrent pediatric glaucoma patients who did not undergo laser in the same practice were used to adjust for any possible learning effect in FDT results. Student t-test analyzed the results.
21 eyes from 11 patients, mean age 11.76 ±(sem)0.51 years (range 8-15) and 38% female and 52% right eye underwent LPI during this time interval. Pre-laser MD was -8.4±1.3 dB and post-laser -2.9±1.0 (p<0.0001). Pre-laser IOP was 15.3±0.91 mmHg and post-laser IOP was 15.1±0.69, (p=0.85). Control group of 22 eyes mean age 10.5±0.50 (range 7-14) had MD on first field of -8.15±1.4 dB (p=0.47 compared to treatment group baseline) and -6.18±1.2 on second field (p<0.05). The mean change in the treatment group was +4.78 versus +1.9 dB in the control group (p=0.009). All treated subjects had resolution of frontal headache.
LPI treatment of pediatric patients with complaints of frontal headache as result of IACG provides both symptomatic relief and substantial recovery of visual function. In this study, the FDT MD improved by 65% within 12 months of LPI, with ¾ of this benefit not attributable to learning effect. All patients noted improvement in headache symptoms. This study suggests that pediatric patients with intermittent angle closure would benefit from treatment with LPI when possible, based on child cooperation and the availability of appropriately skilled staff assistance.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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