Detecting Keratoconus: Feasibility and Findings in Three Pediatric Risk Groups.

PURPOSE: To investigate the utility of three corneal screening devices in three groups of children. METHODS: This was a prospective study of patients with Trisomy 21 (group 1), patients with a first-degree relative with keratoconus (group 2), and control patients (group 3). Informed consent was obtained before testing with the Pentacam (Oculus Optikgeräte GmbH), Orbscan (Orbscan, Inc), and Ocular Response Analyzer (ORA) (Ametek Reichart Technologies). The ability to complete tests, the quality of results, and the corneal parameters obtained for each eye were recorded. A one-way analysis of variance test was used to compare the results between the three groups. RESULTS: Fifty-four patients aged from 7 to 17 years (mean: 11.74 years) were enrolled between July 2014 and July 2016. The number of patients and the percentage of tests completed for groups 1, 2, and 3 were 12 (55%), 21 (87%), and 21 (88%), respectively. The Pentacam values by group were central corneal thickness of 524, 543, and 542 µm (P = .36); thinnest point of 498, 536, and 534 µm (P = .03); corneal front mean keratometry of 44.9, 43.2, and 43.2 (P = .01); and quality score of 1.42, 0.22, and 0.04 (P < .0001), respectively. Orbscan values by group were central corneal thickness of 493, 551, and 550 µm (P = .01) and thinnest point of 451, 536, and 538 µm (P < .0001), respectively. ORA values by group were corneal hysteresis of 10.6, 12.1, and 11.6 (P = .124); corneal resistance factor of 9.9, 11.8, and 11.6 (P = .03); and waveform score of 5.6, 7.6, and 7.3 (P < .0001), respectively. CONCLUSIONS: Patients in group 1 completed fewer tests reliably and had thinner corneas and lower corneal resistance factors than patients in groups 2 and 3. Corneal tests used to evaluate adults for keratoconus may not be reliable for the evaluation of certain high-risk pediatric patients. [J Pediatr Ophthalmol Strabismus. 2022;59(2):94-101.].

Circumferential Trabeculotomy Versus Conventional Angle Surgery: Comparing Long-term Surgical Success and Clinical Outcomes in Children With Primary Congenital Glaucoma.

PURPOSE: This study compares the long-term efficacy of circumferential trabeculotomy to that of conventional angle surgeries in primary congenital glaucoma (PCG), as judged by glaucoma and visual outcomes. DESIGN: Retrospective observational case series. METHODS: Setting: Emory Eye Center, Atlanta, Georgia. STUDY POPULATION: This was a single-institution retrospective study involving children with PCG who underwent circumferential trabeculotomy, standard trabeculotomy, or goniotomy with ≥2-year follow-up. MAIN OUTCOME MEASURES: Postoperative success (intraocular pressure [IOP] < 22 mm Hg ± glaucoma medications, without glaucoma progression/additional IOP-lowering surgery), Snellen-equivalent visual acuity (VA), and IOP at last follow-up. Kaplan-Meier method estimated the probability of glaucoma control vs time postoperatively, and values were compared between angle surgery cohorts using Wilcoxon signed rank tests, Mann-Whitney U tests, and Fisher exact tests. RESULTS: Included were 58 eyes (33 children) after circumferential trabeculotomy and 42 eyes (27 children) after standard trabeculotomy/goniotomy, with mean follow-up of 7.2 ± 4.0 and 8.2 ± 4.5 years, respectively. Postoperative success at last follow-up in the circumferential vs conventional cohorts was 81% (47 of 58 eyes) vs 31% (13 of 42 eyes) (P < .0001). At last follow-up, the circumferential cohort had better median VA than the conventional cohort (20/30 (interquartile range [IQR] 20/25 to 20/70) vs 20/70 (IQR 20/40 to 20/200), P = .009), required fewer glaucoma medications (0.55 ± 1.2 vs 1.61 ± 1.51, P < .0001), had lower IOP in first operated eye (15.2 ± 3.6 vs 18.2 ± 7.0, P = .048), and had comparable incidence of devastating complications (P = .065). CONCLUSIONS: In this retrospective study, circumferential trabeculotomy afforded better long-term success and visual outcomes than conventional angle surgery for children with PCG.

Primary Congenital Glaucoma Versus Glaucoma Following Congenital Cataract Surgery: Comparative Clinical Features and Long-term Outcomes.

PURPOSE: To report and compare visual and glaucoma outcomes in primary congenital glaucoma (PCG) vs glaucoma following congenital cataract surgery (GFCS). DESIGN: Retrospective, observational, comparative case series. METHODS: Setting: Emory Eye Center, Atlanta, Georgia. STUDY POPULATION: Pediatric glaucoma patients (age 0-18 years) treated at Emory by 1 clinician with ≥2-year follow-up. Glaucoma was defined according to the 9th Consensus Report of the World Glaucoma Association. MAIN OUTCOME MEASURES: Snellen-equivalent logMAR visual acuity (VA) and glaucoma control (IOP ≤21, no devastating complications, no recommendation for further glaucoma surgery). Asymptotic Wilcoxon-Mann-Whitney rank sum tests were employed to compare glaucoma subgroups. RESULTS: Included were 72 PCG and 56 GFCS cases, with mean follow-up time of 7.4 ± 4.1 and 8.0 ± 3.8 years, respectively. At last follow-up, PCG showed better median VA than GFCS in worse-seeing eyes (20/60 [interquartile range (IQR) 20/30-20/200] vs 20/400 [IQR 20/70-hand motion], respectively, P < .0001) and in better-seeing eyes of bilaterally-affected children (20/30 [IQR 20/20-20/60] vs 20/70 [IQR 20/35-20/100], respectively, P = .024).The following variables characterized the PCG and GFCS groups' glaucoma status, respectively: mean age at diagnosis (years), 0.70 ± 1.3 vs 3.3 ± 3.5 (P < .0001); median IOP (mm Hg), 15.50 [IQR 12.1-19.4] vs 17.50 [IQR 14.9-22], P = .037; median number of glaucoma medications at last follow-up, 1.49 [IQR 0-2] vs 2.54 [IQR 1-4], P < .0001; median number of glaucoma surgeries, 1.0 [IQR 1-2] vs 1.25 [IQR 0.5-2.0], P = .09. CONCLUSIONS: Children with PCG (vs those with GFCS) presented earlier, had better vision, required fewer medications to control disease, and had lower IOP at last follow-up.

Pediatric glaucoma medical therapy: who more accurately reports medication adherence, the caregiver or the child?

As they grow older, most children with glaucoma must eventually face the transition to self-administering medications. We previously reported factors associated with better or worse medication adherence in children with glaucoma, using an objective, electronic monitor. Utilizing the same data set, the purpose of the current study was to determine whose report (the caregiver's or the child's) corresponded better with electronically monitored adherence. Of the 46 participants (22 girls), the mean age of children primarily responsible, and caregiver primarily responsible for medication administration was 15±2 and 10±2 years, respectively. For the children whose caregiver regularly administered the eyedrops, the caregiver's assessment of drop adherence was associated with measured adherence (P=0.012), but the child's was not (P=0.476). For the children who self-administered eyedrops, neither the child's (P=0.218) nor the caregiver's (P=0.395) assessment was associated with measured percent adherence. This study highlights potential errors when relying on self-reporting of compliance in patients and caregivers with pediatric glaucoma, particularly when the child is responsible for administering their own eyedrops. Frank discussions about the importance of medication adherence and how to improve compliance may help both the child and caregiver better communicate with the treating provider.