Glaucoma: not just a disease of adults
By Robert M. Feldman, MD
Glaucoma is a potentially blinding disease where degeneration of the optic nerve leads to progressive vision loss. In the United States, it is estimated that 2.2 million suffer from glaucoma. The eye is constantly producing aqueous (fluid) that in a normal person’s eye is drained out via a structure called the trabecular meshwork. In people with glaucoma, this drain doesn’t work, resulting in high intraocular pressure and vision loss.
Generally, glaucoma is thought of as an “old person’s” disease. Although rare, glaucoma can affect the pediatric population, often with different signs and symptoms than present in an adult population. Congenital/infantile glaucoma occurs in 1 in every 10,000 births in the United States, and most cases are diagnosed within the first year. These children often have large eyes with cloudy corneas, due to stretching of the eye to accommodate the extra fluid. Excessive tearing and sensitivity to light (manifested by hiding from bright light or squeezing of the eyelids) is also common.
Juvenile glaucoma can be diagnosed at any time during childhood. These children may not have the anatomic abnormalities described above but will be better able to communicate discomfort and other symptoms of glaucoma. Sensitivity to light, vision loss, difficulty adjusting to the dark, headaches or eye pain, frequent blinking or squeezing of the eyelids, and consistent red eyes are some hallmarks of the disease.
Secondary glaucomas can also occur in children. These glaucomas are associated with systemic medical conditions (i.e. Sturge-Weber syndrome, Axenfeld-Rieger syndrome, Marfan syndrome), ocular abnormalities (aniridia and various other congenital conditions), trauma, or after surgery (cataract extraction or due to treatment with steroids).
Early diagnosis and treatment are the crucial to preserve as much vision as possible. In young children, an exam under anesthesia in a hospital setting may be done. Older children can be examined in the office. Follow-up is just as crucial as the initial diagnostic exam to monitor changes in vision and other eye functions. Treatment may include medications or potentially surgery depending on the cause of the glaucoma, but with treatment children can go on to live happy, full lives with good vision.
At the World Glaucoma Congress in Vancouver in July, my departmental colleague Dr. Lauren Blieden and I are gladly meeting with other pediatric glaucoma specialists to develop a consensus on terminology and guidelines for pediatric glaucomas. The goal of this meeting is to provide consistent definitions and standards for treatment so that pediatric glaucoma patients can be effectively helped and the disease researched thoroughly.
Dr. Robert M. Feldman is Richard S. Ruiz, MD Distinguished University Professor and Chairman of the Ruiz Department of Ophthalmology and Visual Science at The University of Texas Medical School in Houston. Along with his departmental colleague Dr. Nicholas P. Bell, he is editor and contributor to Complications of Glaucoma Surgery, which discusses both common and rare complications of glaucoma surgery and how to recognize, prevent, and manage them.
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Image credit: Eye with glaucoma. Photo courtesy of Dr. Robert M. Feldman. All rights reserved. Do not reproduce without permission.