Measuring RAPD with infrared computerized pupillometry can detect optic neuropathy in glaucoma with high sensitivity and specificity. The method is fast and objective. Pupil area amplitude measurements were superior to pupil velocity measurements for the detection of RAPD in glaucoma.

ABSTRACT.Purpose: To describe a paediatric cohort surgically treated for primary or secondary glaucoma (PG/SG), with regard to incidences, visual outcome and control of intraocular pressure (IOP). Methods: All children (n = 29, 42 eyes in total) surgically treated for PG or SG at the age of 4 years or younger between January 2002 and December 2010 at Sahlgrenska University Hospital in M€ olndal were retrospectively studied through medical records. Median follow-up time after initial surgery was 5.9 years (range 2.4-11.2 years). Results: The incidence of primary congenital glaucoma was 4.3 cases per 100 000 live births in the county of V€ astra G€ otaland. For glaucoma secondary to cataract surgery, the incidence was 13% with a median postoperative duration to diagnosis of glaucoma of 3.8 months (range 1.6 months to 4.3 years). Preoperative mean IOP was 31.5 (SD 8.1) mmHg, and mean IOP at last visit was 17.1 (SD 4.4) mmHg. For the entire cohort, 30% of the glaucoma eyes required more than two IOP-lowering surgical procedures during the study period. BCVA was ≥0.3 (decimal) in 45% of glaucomatous eyes at last follow-up with no statistically significant difference between PG and SG. Analysis of functional visual outcome, that is BCVA in the better eye, showed that 83% of all patients attained a BCVA of ≥0.5. Conclusions: The incidences and outcome of surgically treated paediatric glaucoma were in accordance with previous studies. Chamber angle surgery, and if necessary, tube implantation without the use of antimetabolites, is a favourable approach leaving most sites needed for future glaucoma surgery unaffected.

Purpose: To develop a new technique for measuring relative afferent pupillary defect (RAPD) and to find the best stimulus parameters for detecting glaucomatous optic neuropathy. Methods: With a newly constructed pupillometer based on digital video recording, pupillary light reflexes were analyzed during alternating light stimulation. Pupil area was measured in each video frame using computer digital image analysis. The examinations were performed using different sets of stimulus-pause combinations. Subjects with unilateral or asymmetrical glaucoma were studied and compared to normals. Results: Alternating light stimulation of 0.5-s followed by 1-s pause was shown to be the best stimulus pattern for RAPD detection. Conclusion: Infrared pupillometry could distinguish eyes with glaucoma from normal eyes with good sensitivity and specificity.

Purpose The aim of this study was to determine the prevalence of late‐onset glaucoma after surgery for congenital cataract in a cohort with long‐term follow‐up and to evaluate visual development following the diagnosis of postoperative glaucoma in comparison with no glaucoma development. Methods All children born between 1980 and 1997 in the western counties of Sweden who had undergone congenital cataract surgery were included (patients n = 77, eyes n = 122). Cataract was considered congenital if there was no proof of clear lens at birth. Medical records were reviewed with regard to onset of glaucoma, age at surgery, surgical technique, coexisting eye anomalies and changes in visual acuity. Glaucoma was considered late onset if occurring after 1 year following surgery. Results Total glaucoma prevalence was 14.8%, including late (10.7%) and early onset (4.1%), with a mean follow‐up of 23.2 ± 6.6 years. Microphthalmos was a significant risk factor for developing glaucoma (RR 7.75, p < 0.001). Bilaterally treated eyes had a mean visual acuity of 0.43 ± 0.33 (decimal value) at the last follow‐up. With glaucoma, mean visual acuity was 0.19 ± 0.17 (decimal value). Treated eyes of patients with unilateral cataract surgery had a lower visual acuity. Conclusions Life‐long follow‐up of all patients who have undergone surgery for congenital cataract in childhood is recommended. Annual check‐ups of adults, including measurements of IOP and visual acuity, are recommended for patients with microphthalmos and/or who had surgery <3 months of age.