Visual acuity in children with glaucoma

Purpose: To investigate the risk factors that influence outcome of visual function in children with glaucoma. Design: Retrospective noncomparative interventional case series. Participants: One hundred twenty-six patients (204 eyes) who had childhood glaucoma observed over 30 years, with a mean follow-up of 11.6 years. Interventions: Full ophthalmologic examination, including measurement of corrected visual acuity (VA), slit-lamp and fundus examinations, intraocular pressure (IOP) measurement, and gonioscopic evaluation; periodic cycloplegic refraction and perimetry; and treatment of amblyopia. Main Outcome Measures: Type of glaucoma; final best-corrected VA of good (6/6-6/12), fair (6/15-6/30), or poor (<= 6/60); patient age at time of development of glaucoma complications; and percentage of IOP measurements of <= 9 mmHg, perimetry results, and cup-to-disc (C/D) ratio during follow-up. Results: The most recently measured VAs of children treated for glaucoma were good in 29%, fair in 24%, and poor in 47%. The most favorable outcome was for patients with primary infantile glaucoma followed by secondary glaucoma. Amblyopia and optic nerve damage due to glaucoma were the most frequent complications affecting VA. Patients with an IOP of :519 mmHg on 80% of determinations had stable optic nerve C/D ratios and visual fields. Conclusions: Vision sufficient to qualify for a motor vehicle driving license was attainable in almost 30% of affected eyes. Visual acuity achieved at 6 years of age remained stable over the study period. Treatment of amblyopia is important to achieve this result.