Children with pediatric glaucoma often have non-glaucoma related diseases that require subspecialty evaluation and neuroimaging, a study in the Journal of Glaucoma suggests.

While multiple studies have looked at neuro-ophthalmology referrals in adult glaucoma patients, no similar investigations have been conducted for pediatric patients, the research team from Bascom Palmer Eye Institute says.

The investigators did a retrospective review of medical records to identify pediatric patients evaluated by both glaucoma and neuro-ophthalmology at Bascom Palmer Eye Institute from 2013 to 2018.

The study included 59 patients who were approximately 10 years old. The majority of patients, 88.1%, were referred from pediatric glaucoma to neuro-ophthalmology. The most common reasons for referral included suspected non-glaucomatous optic neuropathy, optic disc swelling, color vision deficiency and non-glaucomatous visual field defect. Referral to neuro-ophthalmology resulted in neuro-imaging in 42.3% of patients, and pathology was found on the scan of 13.7%. Ultimately, 73.1% of patients referred to neuro-ophthalmology had a diagnosis unrelated to glaucoma.

Also of note: color vision abnormality, optic nerve pallor, and/or retinal nerve fiber layer less than 70µm in at least one eye were linked to a diagnosis unrelated to glaucoma. Of the seven patients referred from neuro-ophthalmology to pediatric glaucoma, none were diagnosed with glaucoma or started on intraocular pressure-lowering therapy.

These results can help guide future referrals and improve patient outcomes, the researchers noted.

Tirpack AR, Vanner EA, Sheheitli H, et al. Neuro-ophthalmic disease in pediatric glaucoma practice. J Glaucoma. December 9, 2019. [Epub ahead of print].