Surgeon: Aim for IOP of 19 mm Hg or less in pediatric glaucoma patients

ORLANDO, Fla. — Clinicians should aim for target IOP levels of 19 mm Hg or less in children with glaucoma to prevent disease progression, according to a speaker here.

Albert W. Biglan, MD, discussed strategies in pediatric glaucoma management in the annual Frank D. Costenbader lecture at the American Association for Pediatric Ophthalmology and Strabismus meeting.

“While an IOP of 21 mm Hg to 24 mm Hg is the standard for adults with glaucoma, children should have lower target pressures because they tend to have lower IOP in general,” Dr. Biglan said.

He presented the outcomes of a 30-year retrospective study from the Western Pennsylvania School for Blind Children that included the charts of 124 children. Of 204 eyes in the study, 52 eyes were diagnosed with infantile glaucoma, 40 eyes had aphakic glaucoma, 43 eyes had secondary glaucoma and 69 eyes had syndrome-associated glaucoma. Visual acuity, IOP, refractive error, disc configuration and perimetry were recorded at ages 6, 12, 18 and 24.

The study found that children who had a stable IOP of 19 mm Hg or less at 80% of their follow-up visits maintained stable optic nerve and disc configuration ratios. Patients with infantile glaucoma tended to have the best visual acuities, with 40% of those patients achieving 20/40 vision or better, Dr. Biglan said. Patients with aphakic glaucoma tended to have the worst visual acuity, he said, with 6.5% of patients achieving 20/40 or better. Forty-five percent of children studied were legally blind or had visual acuities of 20/200 or less.

Dr. Biglan said maintaining target IOP in childhood glaucoma is “just one component” of preventing blindness. Forty-six percent of children with glaucoma in the study experienced vision loss primarily from amblyopia.

“Maintaining IOP is [important],” Dr. Biglan said, “But managing amblyopia may be even more important in the first 8 years of life.”