Predictors of Long Term Visual Acuity and Intraocular Pressure Outcomes in Childhood Glaucoma: A Multicenter Study by the Childhood Glaucoma Research Network (CGRN).

Abstract

Precis: This study identifies visual acuity and intraocular pressure at 3- and 5-year follow-ups, along with other variables such as media opacity and nystagmus, as key predictors of long-term outcomes in childhood glaucoma, aiding better management and prognostication.

Purpose: This study aims to identify key predictive variables of visual acuity (VA) and intraocular pressure (IOP) outcomes in childhood glaucoma. By understanding these factors, the study seeks to improve prognostication and management strategies for pediatric patients.

Methods: A retrospective analysis was conducted on pediatric glaucoma patients across multiple centers within the Childhood Glaucoma Research Network (CGRN). The study included patients with at least 5 years of follow-up. Variables such as sex, race, ethnicity, age of onset, laterality, and clinical measures including VA and IOP at various stages (initial visit, 3-year, 5-year, and final visits) were evaluated. Additional factors considered were anisometropia, media opacities, nystagmus, anterior segment dysgenesis (ASD), strabismus, and angle closure.

Results: The study included 396 eyes from 243 patients, with a mean age at presentation of 1.5 months. Several variables showed statistically and clinically significant correlations with final outcomes including IOP and VA at both 3-year and 5-year visits, as well as the presence of media opacities, unilateral glaucoma, nystagmus, and ASD. Based on multivariable prediction model analysis the two statistically significant predictors for visual acuity (n=31) were VA at 5-year visit and presence of angle closure. As for IOP outcomes (n=31), significant predictors included were IOP at 5-year visit and presence of nystagmus.

Conclusions: This multicenter study highlights that VA and IOP measurements at 3 and 5 years post-diagnosis, along with the presence of specific ocular conditions such as media opacity and nystagmus, are crucial in predicting long-term outcomes in childhood glaucoma.