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  • Glaucoma, Pediatric Ophth/Strabismus

    Review of: Clinical outcomes in children and adolescents referred for increased cup:disk ratio at a tertiary referral center

    Al-Holou S, Wong M, Zhang Q, et al. Journal of American Association for Pediatric Ophthalmology and Strabismus, in press 2023

    A small percentage of children who are seen for increased cup–disc ratio (CDR) will develop glaucoma, most commonly in the first months following presentation.

    Study design

    This single-center study retrospectively evaluated clinical outcomes and risk factors for glaucoma in children and adolescents aged <18 years (average age 10.3 years) referred for CDR >0.6 between 2011 and 2019. Patients with known ocular diseases were excluded from the study.


    Six of 167 patients developed glaucoma over the study period. Although 61 patients had more than 2 years of follow up, all glaucoma diagnoses were made within 3 months of initial evaluation. Eight patients were found to have previously unrecognized anterior segment dysgenesis. Only baseline IOP and maximal IOP on diurnal curve were statistically significant for glaucoma diagnosis. A greater range of IOP measurements during diurnal curve was more frequently seen in patients with a glaucoma diagnosis, but this did not reach statistical significance.


    Limitations of the study include its retrospective nature and the fact that the patient population was limited to those seen at a single tertiary referral center, leading to a small number of identified patients with glaucoma.

    Clinical significance

    A small percentage of patients referred to a tertiary referral practice for glaucoma evaluation for increased CDR alone went on to develop glaucoma during the study period. That all of these cases were identified within the first 3 months after presentation underscores the importance of a detailed initial evaluation, including examination of the anterior segment and diurnal curves as well as OCT when possible.

    Financial Disclosures: Dr. Phoebe Lenhart discloses no financial relationships.