Few children with increased cup–disc ratio go on to develop glaucoma

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.

Outcomes

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

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.