Neuro-ophthalmic Disease in Pediatric Glaucoma Practice

Aubrey R. Tirpack, Elizabeth A. Vanner, Huda Sheheitli, Carlos E. Mendoza, Alana Grajewski, Ta C. Chang

Research output: Contribution to journalArticle

Abstract

Precis: Pediatric glaucoma referral to neuro-ophthalmology has a high yield for diagnosing neurologic disease and neuroimaging in this cohort often uncovers intracranial abnormalities. Purpose: Multiple studies have examined the utility of neuro-ophthalmology referrals in an adult glaucoma patient population. No similar studies in the pediatric glaucoma population have been completed. An analysis of pediatric referral patterns and clinical characteristics can serve to guide future physician referrals and improve patient outcomes. Patients and Methods: A retrospective review of medical records was conducted to identify pediatric patients evaluated by both glaucoma and neuro-ophthalmology services at Bascom Palmer Eye Institute from January 2013 to August 2018. Records were reviewed for clinical exam findings, demographics, ophthalmic imaging, neuroimaging, and ultimate diagnosis. Results: 59 patients, average age 10-years-old, were included for analysis. The majority of patients were referred from pediatric glaucoma to neuro-ophthalmology (n=52, 88.1%). The most common reasons for referral included suspected nonglaucomatous optic neuropathy (n=14), optic disc swelling (n=7), color vision deficiency (n=6), and nonglaucomatous visual field defect (n=4). Referral to neuro-ophthalmology resulted in neuro-imaging in 22 patients (22/52, 42.3%), with 7 patients (7/52, 13.7%) having pathology on the scan. Ultimately, 38 patients (73.1%) referred to neuro-ophthalmology had an ultimate diagnosis unrelated to glaucoma. Color vision abnormality, optic nerve pallor, and/or retinal nerve fiber layer <70▒um in at least one eye were associated with a diagnosis unrelated to glaucoma. Of the 7 patients referred from neuro-ophthalmology to pediatric glaucoma, none were diagnosed with glaucoma or started on intraocular pressure lowering therapy. Conclusions: Patients referred from pediatric glaucoma to neuro-ophthalmology often have nonglaucomatous disease requiring subspecialty evaluation and neuroimaging. Neuroimaging in this cohort is high yield for uncovering intracranial pathology.

Original languageEnglish (US)
JournalJournal of glaucoma
DOIs
StateAccepted/In press - Jan 1 2019

Keywords

  • glaucoma
  • neuro-ophthalmology
  • optic neuropathy
  • pediatric glaucoma

ASJC Scopus subject areas

  • Ophthalmology

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