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Corneal changes in children with glaucoma contribute to visual disability
A study recently published in Ophthalmology found that childhood glaucoma causes a significant increase in irregular astigmatism and posterior corneal elevation.
Patil and colleagues conducted a cross-sectional, observational study to evaluate topographic and clinical corneal changes.
Researchers assessed 58 eyes with childhood glaucoma and 28 eyes of age-matched controls. Of the eyes with glaucoma, 36 were determined to have primary childhood glaucoma and 22 were determined to have childhood glaucoma with associated ocular anomalies.
As detailed in the study, researchers utilized Orbscan (Orbscan Topography System II; Bausch + Lomb) to measure corneal topographic changes.
Results showed that Haab's striae were found in 26 eyes, and corneal posterior elevation was significantly higher in eyes with childhood glaucoma; researchers determined that the presence of Haab's striae was associated with a higher posterior elevation as well as poorer visual acuity.
Additionally, eyes with childhood glaucoma had significantly higher and irregular astigmatism than control eyes.
"Childhood glaucoma causes a significant increase in posterior corneal elevation and irregular astigmatism," the authors concluded. "These, together with glaucomatous optic neuropathy, may contribute significantly to the visual dysfunction and amblyopia commonly seen in such patients. Thus, besides IOP control, a good refraction and correction of astigmatism, along with amblyopia management, should be mandatory components of childhood glaucoma management."
Disclosure: The authors have no proprietary or commercial interest in any materials discussed in this article.
Perspective
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Despite timely and aggressive treatment, patients with childhood glaucoma can still develop significant and permanent vision loss. Childhood glaucoma is often associated with myopia and amblyopia, with early intervention crucial for long-term visual success.
In this study, the authors determined those patients with childhood glaucoma had significantly higher amounts of irregular astigmatism and corneal posterior elevation than control eyes. In addition, the presence of Haab's striae was associated with a higher posterior elevation as well as poorer visual acuity.
Increased posterior corneal elevation is likely secondary to increased intraocular pressure acting on the posterior corneal surface, increasing the amount of irregular astigmatism that would not be detected on keratometry, as the anterior surface is unaffected. With the addition of childhood glaucoma, patients typically having a higher amount of myopia, and this could lead to the child developing amblyopia.
It is recommended that patients with childhood glaucoma not only receive aggressive treatment for the glaucoma and IOP management, but also a comprehensive refractive assessment, with consideration of the increased prevalence of posterior elevation resulting in irregular astigmatism and higher-order aberrations that a clinician would not necessarily expect in a child.