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Editors Selection IGR 9-3

Clinical Forms of Glaucoma: Childhood Glaucoma Suspects

Comment by Ze Zhang & Wallace Alward on:

74465 Clinical management outcomes of childhood glaucoma suspects, Greenberg MB; Osigian CJ; Cavuoto KM et al., PLoS ONE, 2017; 12: e0185546

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Greenberg et al. reported a succinct retrospective series of outcomes of childhood glaucoma suspects with 39+/- 34 months of follow-up from a single large tertiary referral center.

They found that up to 25% of children with 2 or more episodes of elevated IOP above 21 may develop glaucoma. The authors found no significant difference in gender, family history, or baseline central corneal thickness between those who developed glaucoma and those who did not. There was a trend for higher IOPs in those who developed glaucoma.

The authors are among the first to start filling a gap in the literature regarding the characteristics of childhood glaucoma suspects for conversion to glaucoma. While many trials have examined risk factors for glaucoma and the clinical course of glaucoma suspects in the adult population, similar knowledge specific to the pediatric population is sparse.

In this study of childhood glaucoma suspects, only 50% of those who developed glaucoma had an elevated IOP greater than 21 mmHg at baseline. Of the 44.4% of patients who demonstrated 2 or more episodes of elevated IOP, 25.6% developed glaucoma with a mean follow up of 2.8 years.

While many trials have examined risk factors for glaucoma and the clinical course of glaucoma suspects in the adult population, similar knowledge specific to the pediatric population is sparse

The manuscript brings up important considerations in the long-term management of pediatric glaucoma suspects. The results show that long-term follow up is very important. Absence of family history of glaucoma, normal baseline IOP, and normal CCT do not preclude the development of glaucoma over the long run. It may be that risk factors for glaucoma in pediatric patients differ from those of the adult population. The retrospective design and the single tertiary referral center for patient cohort limits the generalizability of the results. The study does highlights the need for a prospective longitudinal multi-centered study examining the clinical outcomes and incidence of childhood glaucoma to better elucidate risk factors for glaucoma development in the pediatric population.

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