Childhood glaucoma

Glaucoma in children can be more difficult to diagnose and to monitor for disease progression compared with that in adults because of the challenge of obtaining reliable and reproducible visual fields and intraocular pressure (IOP) measurements. Optical coherence tomography (OCT) has revolutionized the evaluation and management of glaucoma in cooperative children by providing detailed quantifiable measurements of the peripapillary retinal nerve fiber layer (RNFL) as well as macular thickness. There are, however, limitations of OCT measurement in the pediatric population different from those of OCT in adults, including the need for fast acquisition time and eye tracking as well as lack of a well-defined normative database for pediatric RNFL measurements. Therefore pediatric OCT is more useful for longitudinal follow-up than for determinations of “normal” on initial testing. OCT has also proven to be useful in nonglaucomatous pediatric optic nerve disorders, including optic nerve hypoplasia, optic nerve coloboma, megalopapillae, and central nervous system (CNS) pathology manifesting as optic atrophy. Future advances in OCT technology may allow for its use in even the least cooperative pediatric patients in a sedated setting.