Anisohypermetropia as a sign of unilateral glaucoma in the pediatric population.

Childhood glaucoma poses a diagnostic and therapeutic challenge to ophthalmologists. Difficulty in examination and limitations on ability to perform structural and functional testing of optic nerve make diagnosis and verification of glaucoma control difficult in children. It is well known that an excessive loss of hyperopia is a useful sign in alerting the examining ophthalmologist to the possible diagnosis of glaucoma. We present an interesting case of juvenile onset glaucoma presenting with anisohypermetropic amblyopia in one eye and normal vision in the fellow eye that has glaucoma. It is an unusual case as the left eye with abnormal vision from hypermetropic amblyopia, though by itself requiring treatment, was a red herring for a potentially blinding condition in the fellow eye with normal vision and lower and less amblyogenic hyperopia on examination. We believe that glaucomatous enlargement of the right eye resulted in significant loss of hyperopia in that eye and in turn contributed to anisohypermetropic amblyopia in the left eye. To the best of our knowledge, this is the first reported case of juvenile onset glaucoma presenting with anisohypermetropic amblyopia in one eye and normal vision in the fellow eye that has glaucoma.

Structural Differences in the Optic Nerve Head of Glaucoma Patients With and Without Disc Hemorrhages.

PURPOSE: The aim of the study was to evaluate differences in planimetry, optic nerve parameters, and visual field (VF) indices in glaucomatous eyes with a disc hemorrhage (DH), their contralateral counterparts without DH, and normal controls. PATIENTS AND METHODS: We retrospectively reviewed the records (from 1995 to 2013) of 44 glaucoma subjects with unilateral DH and 50 normal controls. In the DH group, 33 had bilateral fundus photos for planimetric analysis (Cyoptique GL), 15 had spectral domain-optical coherence tomography (SD-OCT), 15 had VF indices (Humphrey Visual Field Analyser), and 39 had ≥ 5 perimetry outputs for progression analysis (Progressor). RESULTS: Structurally, planimetric analysis revealed that the eye with DH had a larger cup-disc ratio, more significantly in the vertical aspect (P<0.001), and a thinner rim (P=0.010), compared with the contralateral eye without DH. SD-OCT analysis also showed a thinner rim area (P<0.001), most significantly in 2, 3, and 9 clock hours and the inferior and superior quadrants (P<0.001) compared with the contralateral eye without DH and normal controls. Also, the vertical cup-disc ratio was larger (P<0.001). Functionally, VF deterioration was demonstrated by VF indices in eyes with DH-mean deviation: -10.69 versus -0.97, P<0.001 and pattern standard deviation: 6.60 versus 1.59, P<0.001, compared with normal controls. CONCLUSIONS: Eyes with DH consistently displayed both structural features of more advanced glaucoma confirmed simultaneously on planimetry and SD-OCT, with concurrent VF deterioration.