Long-Term Structural and Functional Outcomes of Therapy in Juvenile-Onset Primary Open-Angle Glaucoma : A Five-Year Follow-Up

Abstract

Objective: To evaluate long-term structural and functional changes of the optic nerve head in medically and surgically treated juvenile-onset primary open-angle glaucoma (JOAG). Methods: Forty-two eyes of 42 consecutive primary JOAG patients presenting between January 2000 and January 2003. Results were analysed for long-term intra-ocular pressure (IOP) control, IOP fluctuation, disc characteristics on a Heidelberg Retinal Tomograph II and for visual field changes over a 5-year period. The parameters were compared between medically and surgically treated eyes. Results: The average age of the patients was 26.8 ± 6.1 years. The average baseline IOP was 35.3 ± 14.9 mm Hg. An IOP control <18 mm Hg was achieved in 84% of eyes that underwent filtering surgery (n = 17), compared to 63% on medical therapy alone (n = 25) at the end of 5 years; log rank test p = 0.38. Over 5 years, 4 eyes showed progression (9.5%) of which 3 had been medically treated and 1 had failed surgery (p = 0.45). Conclusion: A tenth of JOAG eyes showed progression over 5 years, and this was more common in those treated medically. Aggressive IOP lowering may thus be needed in eyes with JOAG.

Clinical Characteristics of Juvenile-onset Open Angle Glaucoma

“…In this study, we demonstrated that JOAG patients had a male preponderance, myopic refractive state and severe elevation of IOP; these findings were similar to those of previous reports [ 8 12 13 14 ]. Bilateral JOAG patients were older and made up a higher proportion of those with a family history of glaucoma than unilateral JOAG patients.…”

Risk of perimetric blindness among juvenile glaucoma patients

“…Because of high IOP, JOAG patients may have rapid progression without medical intervention that may lead to early blindness. Progression of the disease, over a 5 year period has been noted to occur in about 10% of treated JOAG eyes . Estimating the progression of glaucoma and the risk of blindness in young patients is important as they belong to a socially productive age group and blindness among them is a greater economic burden to society than glaucoma in the older age group.…”

Anisohypermetropia as a sign of unilateral glaucoma in the pediatric population

“…However, since JOAG has also been postulated to be a subset of adult POAG with an earlier age of onset, it may be possible to give these patients a trial of medical therapy 26. Gupta et al20 found in their cohort of high-pressure JOAG patients that medical therapy alone could control IOP and prevent glaucomatous progression in 52% of their patients over a 5-year follow-up. Success of medical therapy could be related to the severity of angle dysgenesis.…”