advertisement

Topcon

Abstract #84719 Published in IGR 21-1

Neuro-ophthalmic Disease in Pediatric Glaucoma Practice

Tirpack AR; Tirpack AR; Vanner EA; Sheheitli H; Mendoza CE; Grajewski A; Chang TC
Journal of Glaucoma 2020; 29: 117-123


PRECIS: Pediatric glaucoma referral to neuro-ophthalmology has a high yield for diagnosing neurological disease and neuroimaging in this cohort often uncovers intracranial abnormalities. PURPOSE: Multiple studies have examined the utility of neuro-ophthalmology referrals in an adult glaucoma patient population. No similar studies in the pediatric glaucoma population have been completed. An analysis of pediatric referral patterns and clinical characteristics can serve to guide future physician referrals and improve patient outcomes. MATERIALS AND METHODS: A retrospective review of medical records was conducted to identify pediatric patients evaluated by both glaucoma and neuro-ophthalmology services at Bascom Palmer Eye Institute from January 2013 to August 2018. Records were reviewed for clinical examination findings, demographics, ophthalmic imaging, neuroimaging, and ultimate diagnosis. RESULTS: A total of 59 patients, average age 10 years old, were included for analysis. The majority of patients were referred from pediatric glaucoma to neuro-ophthalmology (n=52, 88.1%). The most common reasons for referral included suspected nonglaucomatous optic neuropathy (n=14), optic disc swelling (n=7), color vision deficiency (n=6), and nonglaucomatous visual field defect (n=4). Referral to neuro-ophthalmology resulted in neuro-imaging in 22 patients (22/52, 42.3%), with 7 patients (7/52, 13.7%) having pathology on the scan. Ultimately, 38 patients (73.1%) referred to neuro-ophthalmology had an ultimate diagnosis unrelated to glaucoma. Color vision abnormality, optic nerve pallor, and/or retinal nerve fiber layer <70 µm in at least 1 eye were associated with a diagnosis unrelated to glaucoma. Of the 7 patients referred from neuro-ophthalmology to pediatric glaucoma, none were diagnosed with glaucoma or started on intraocular pressure lowering therapy. CONCLUSIONS: Patients referred from pediatric glaucoma to neuro-ophthalmology often have nonglaucomatous disease requiring subspecialty evaluation and neuroimaging. Neuroimaging in this cohort is high yield for uncovering intracranial pathology.

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.

Full article

Classification:

9.1.2 Juvenile glaucoma (Part of: 9 Clinical forms of glaucomas > 9.1 Developmental glaucomas)
9.4.15 Glaucoma in relation to systemic disease (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
2.16 Chiasma and retrochiasmal central nervous system (Part of: 2 Anatomical structures in glaucoma)



Issue 21-1

Change Issue


advertisement

Oculus