Abstract
Purpose :
To evaluate the characteristics of pediatric glaucoma patients with moderate and poor best corrected visual acuity compared to those with good visual acuity.
Methods :
A retrospective review of electronic medical records from 2001 to 2019 was conducted for pediatric glaucoma patients or adults with history of pediatric glaucoma diagnosis or treatment. Visual acuity, failed amblyopia treatment, refractive status, axial length, strabismus, nystagmus, failed angle surgery, and media opacity were recorded. Patients without data for the best corrected visual acuity were excluded. Patients were categorized by their most recent WHO visual acuity (VA) status (poor VA <20/200, moderate VA <20/50 to 20/200, and good VA 20/20 to 20/50) and analyzed. One-way ANOVA testing was used to assess axial length differences among the VA groups, while Chi squared testing was used for the remaining variables.
Results :
233 glaucomatous eyes of 142 childhood glaucoma patients were identified. Average follow-up duration was 6.85 ± 4.46 years. 91 patients had bilateral glaucoma. There were 65 eyes with poor VA of which 22 (33.8%) had failed amblyopia therapy, compared to 16 (28.6%) of the 56 moderate VA eyes, and 1 (0.89%) of the 112 eyes with good VA who failed amblyopia therapy (p<0.00001). Failed angle surgery was observed in 29.2% of poor VA eyes, 35.7% of moderate VA eyes, and 25% of good VA eyes (p=0.35). The mean axial length for eyes with poor VA was 25.27mm, moderate VA 25.70mm, and good VA 23.91mm (p=0.37). Thirty of the 65 (46.2%) poor VA eyes had media opacity while 17 of the 56 (30.4%) moderate VA eyes and six of the 112 (5.36%) good VA eyes had media opacity respectively (p<0.00001). Strabismus was seen in 7.69% of poor VA eyes, 12.5% of moderate VA eyes, and 1.79% of good VA eyes (p=0.02). Similarly, nystagmus was found in 13.8% of poor VA eyes, 16.0% of moderate VA eyes, and 0.89% of good VA eyes (p=0.0005). Finally, anisometropia was found in 23.1% of poor VA eyes, 35.7% of moderate VA eyes, and 28.6% of good VA eyes (p=0.31).
Conclusions :
Eyes with poor and moderate visual acuities tended to have increased rates of media opacity, failed amblyopia therapy, nystagmus, strabismus, and increased axial length though the latter was not statistically significant. Failed amblyopia therapy seems to be by far the most common association with poor vision. Failed angle surgery was not associated with poorer visual acuity.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.