Multidisciplinary approach needed for childhood glaucoma

Peter A. Netland, MD, PhD, said ophthalmologists need to work with parents and other professionals to treat childhood glaucoma.

NEW YORK – Physicians must work alongside teachers, mobility instructors, low-vision specialists and parents to manage and treat childhood glaucoma effectively, said Peter A. Netland, MD, PhD.

“Treatment absolutely requires a multidisciplinary approach,” he said. “You must mobilize your whole team. You really can’t do it alone.”

Dr. Netland said that, with proper care, the prognosis for childhood glaucoma can be good, with few cases of severe vision loss and blindness. He said multiple factors must be taken into account when seeing young glaucoma patients for the first time. One important factor is the anatomy of the angle.

“Angle closure can occur in children. It’s not common, but it’s very important to see what the angle is,” he said.

Other factors to take note of on initial evaluation of a patient with pediatric glaucoma include age, corneal clarity, corneal diameter, systemic disease, the severity of glaucoma, and race and ethnicity, and a history of previous failed surgery.

Dr. Netland said that, for patients with intractable glaucoma, repeated goniotomy or trabeculotomy can be effective. Trabeculectomy with antifibrotic agents, glaucoma drainage implants and cyclodestructive procedures can also be considered.

Dr. Netland spoke here at the New Frontiers in Glaucoma II meeting presented by Columbia University.