A multicenter retrospective study from the Childhood Glaucoma Research Network (CGRN) identified early clinical predictors of long-term visual acuity (VA) and intraocular pressure (IOP) outcomes in childhood glaucoma by analyzing more than 5 years of follow-up. The cohort included 396 eyes from 243 children who were a mean age of 1.5 months at presentation, though 70.4% of patients experienced glaucoma onset before 6 weeks of age.

Univariate analyses demonstrated several factors that were associated with worse final VA, including higher VA LogMAR at 3-year and 5-year visits, higher IOP at 3-year and 5-year visits, media opacities, nystagmus, and anterior segment dysgenesis. Visual acuity at visit 1 (mean difference [MD] 0.54, P=0.013) was also associated with statistically significant increases in final VA. Worse final IOP was associated with bilateral glaucoma, higher IOP at 3-year and 5-year visits, and worse VA at 3-year and 5-year visits.

Multivariable models of 31 eyes identified 2 statistically significant predictors of final visual acuity: VA at the 5-year visit (MD 0.71) and presence of angle closure (MD 1.61). For final IOP, significant predictors included IOP at the 5-year visit (MD 0.63) and presence of nystagmus (MD −6.43).

Led by Huda Sheheitli, MD, of the Department of Ophthalmology and Visual Neurosciences at the University of Minnesota in Minneapolis, the researchers evaluated clinical factors including VA, IOP, refractive error, laterality, and ocular comorbidities such as media opacities and nystagmus at initial, 3-year, 5-year, and final visits. According to their article in the Journal of Glaucoma, all patients were diagnosed at age 3 years or younger. At the final visit (mean follow-up 9.5 years), mean LogMAR VA was 0.7, and two-thirds of eyes (66.9%) achieved an IOP between 5 and 21 mm Hg. Almost half (49.7%) achieved IOP between 5 mm Hg and 18 mm Hg, and 34.1% achieved IOP between 5 mm Hg and 15 mm Hg. Nearly 61% of patients developed bilateral glaucoma over time, including patients who were diagnosed with unilateral glaucoma at baseline and developed glaucoma in the fellow eye during follow-up, as well as patients who were diagnosed with bilateral glaucoma at baseline.

Dr. Sheheitli and colleagues reported that missing demographic data and the limitations of nonverbal visual assessment affected analysis strength: 36% of eyes had final VA data and 90.4% had final IOP data. Prospective multicenter data may better validate prognostic indicators, they suggested. They proposed the development of a severity staging system that expands on prior CGRN classification efforts. While the current system has “facilitated the comparison of different interventions among patients with similar disease severities and allowed short-term prediction of IOP control up to 25 months postintervention….it [falls] short of addressing visual outcomes,” the authors described.

“Creating a severity classification for childhood glaucoma will enable the implementation of standardized treatment guidelines, promoting more consistent and efficient care for children with glaucoma,” Dr. Sheheitli and colleagues wrote. “This system could greatly improve clinical decision-making and enhance the ability to predict long-term outcomes in affected children.”