Chat Highlights
Childhood Glaucoma
May 2, 2001

Norma Devine, Editor

On Wednesday, May 2, 2001, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Childhood Glaucoma." 

Moderator:  The topic tonight is Childhood Glaucoma.

Dr. Wilson:  After my son Phillip was born, dealing with congenital glaucoma became even harder, because I could identify with the parents so closely and what they were going through.  When Phillip was about two months old, I examined his eyes and saw that he had 0.85 cups.  My heart and face fell.  Luckily, he only had large discs and does not have glaucoma.

P:  My son, who is 18 years old, was told to use Timoptic eye drops for pressures of 28 and 32.  What are the side effects?  He's a runner.

Dr. Wilson:  How big is he?  Usually at that age (18), the only side effect he will get is a decreased maximum heart rate and decreased maximum  exercise tolerance.

P:  He's 5' 7" inches tall and weighs 145 pounds. 

Dr. Wilson:  If he is a runner, Alphagan or Xalatan would be a more appropriate drug. 

P:  Is it considered glaucoma if there is no damage, only elevated pressure?

Dr. Wilson:  Not definite glaucoma, but certainly enough evidence to treat if the IOP is around 30.

P:  When do most doctors start testing for glaucoma?  My doctor wasn't going to test my son because he is only 18.  He only tested  him when we insisted. 

Dr. Wilson:  Most doctors start testing for glaucoma in the teens.

P:  Does high pressure ever go away, or will my son be on drops forever?

Dr. Wilson:  Until we develop the Draino drug to get rid of debris in the drain, I think your son will need to take medication.

P:  My younger son will be 13 in August.  Should I test him immediately?  Can we make an appointment with you?

Dr. Wilson:  Yes.  E-mail me through the website and I can find out where he should be seen.

P:  What's the difference between congenital glaucoma and regular glaucoma?

Dr. Wilson:  In congenital glaucoma, the outflow apparatus of the eye is not formed correctly, so that fluid formed naturally in the eye cannot exit the eye fast enough and backs up.  In chronic open-angle glaucoma, either debris is forming too rapidly or is not being cleared away fast enough.  The end result is the same:  damage to the optic nerve from an IOP (intraocular pressure) that is too high for the nerve to tolerate.

P:  I am 31 years old and have congenital glaucoma.  I had surgery when I was 18 months old and again in 1971.  I never needed any medications until last year when the IOP went up to the mid 20's.  I am using Timoptic XE and Xalatan, and my pressure is down to 11 in both eyes.  I do not understand why I was fine all those years, then all of a sudden my pressure went up like that.  

Dr. Wilson:  It was excellent surgery if you have been controlled this long.  Surgery in 1971 was not that advanced.  There may be a build-up of debris in the functioning part of the trabecular meshwork. You may have not had any excess capacity like normal patients have as they get older.

P:  My doctors says that's from my glaucoma as a child.  Now I have corneal edema.   

Dr. Wilson:  That's called Haab's striae, which are a consequence of the cornea being expanded by the pressure in the eye faster than the inner layer (Descemet's) can stretch.  It pops, leaving those wrinkles in the inner lining of the cornea.

P:  Is my pressure of 11 too low?  I am worried about the side effects of the medicine. 

Dr. Wilson:  No, it's not too low.  I would worry far less about the medicine side-effects than the effects of the IOP if it were not held in control.  I have my dad, who is 95 years old, on timolol and Xalatan.  

P:  Are there any other medications for corneal edema besides Mure 128?  Will I need a transplant some day? 

Dr. Wilson:  Probably.  No, there are no other meds that I know of. 

P:  As the first known member of my family with glaucoma (normal tension glaucoma),  I have alerted my grown sons to have an ophthalmologist check them annually.  What about grandkids?  Is the same pressure test used for children?

Dr. Wilson:  Yes.

Moderator:  Is there a difference between childhood and congenital glaucoma?

Dr. Wilson:  Childhood glaucoma that does not have other causes, like inflammation or trauma, is probably a more subtle abnormality of the outflow than congenital glaucoma, but the abnormality has not been discovered.

P:  Why do trabeculotomies only work in pediatric patients?

Dr. Wilson:  We think it is because there is an abnormally high attachment of the iris that covers the working part of the trabecular meshwork.  By opening up Schlemm's Canal to the inside of the eye, this obstruction is relieved. Theoretically, this should work in adults and does to some extent.  The Japanese use this type of surgery at all ages, but we feel we do better with trabeculectomies in those over three years of age. 

P:  Is it possible that children might have high IOP as part of the growth process and then "outgrow" the condition as their bodies develop further?

Dr. Wilson:  No, because we check them at birth to older age and the IOP gradually rises from eight to ten as an infant to normal adult levels.

P:  I was diagnosed at age 24 with pigmentary glaucoma and had a lot of damage. My children are seven and eight years old.  When should I have them checked?

Dr. Wilson:  Pigmentary glaucoma is partially hereditary, but is seen almost exclusively in near-sighted patients over age 20.  I would have them see a pediatric ophthalmologist, if I were you.

P:  Do you treat patients differently according to their age?  Would you threat a 17-year-old with glaucoma differently than a 60-year-old?

Dr. Wilson:  Absolutely.   I would treat the teenager more aggressively, but maybe not aim for as low an IOP as I would an older patient who may well have poor circulation.

P:  There is a history of glaucoma in my family, and my son has just found his pressure is high.  Both of my grandchildren, ages eight and ten, are near-sighted.  How soon should they be tested for glaucoma?  

Dr. Wilson:  Before they start school, i.e., a couple of years ago. 

P:  Would getting a trabeculectomy or shunt at an early age create problems when the person gets older?

Dr. Wilson:  The conjunctiva overlying a trabeculectomy can become thin, leak and even allow bacteria into the eye, causing a dangerous infection. 

P:  If a teen has glaucoma and is nearsighted, would you advise against contact lenses?

Dr. Wilson:  No, I think that is reasonable.

P:  When I first got my eye glasses, I had an air puff  test for pressure and nothing was said about glaucoma.   A year later I could not see out of my left eye.  Is it possible for pigmentary glaucoma to come on that fast with that much damage?

Dr. Wilson:  Probably not.  

P:  My pressure was 12 in October and I had visual loss, according to my glaucoma specialist.  He told me that my visual field test showed that I've definitely had glaucoma for many months.  However, it wasn't until December when my pressure  jumped to 28 that my doctor realized that I might have glaucoma.  Do you ever hear of cases like that?

Dr. Wilson:  Your IOP could have been 12 at one point of every day and 28 at another point,  so whenever the doctor checked it he would have a different impression of how you were doing.  One of the huge problems of managing glaucoma is you only get a few seconds' snapshot of a patient's IOPs.

P:  Is there any special training or certification required for glaucoma doctors to treat children, for glaucoma only, that is? 

Dr. Wilson:  No special training is required at this time,  although it probably should be.

P:   Is laser effective for young people with glaucoma?

Dr. Wilson:  If you are young, i.e., less that 50, a laser trabeculoplasty will not work well or for long.

On May 9, Dr. Wilson discussed "New Glaucoma Medications" in the Chat room. Click here for highlights of that meeting.

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