Duke is one of only a handful of eye centers in the U.S. with internationally recognized experts who provide comprehensive care to children with glaucoma. Glaucoma control often requires multiple exams, medications and procedures. We help you and your child face the challenges associated with diagnosing and treating childhood glaucoma.
Caring for children with glaucoma
Childhood glaucoma comprises a group of disorders characterized by high eye pressure that – if left untreated – can cause permanent vision loss and disfigurement in infants and children. Primary or congenital glaucoma may present at birth or in the first year of life. Childhood glaucoma may occur as a complication of an underlying eye condition such as uveitis (inflammation), trauma, or removal of a congenital cataract. It can also result from a systemic condition such as neurofibromatosis or Sturge weber syndrome.
Diagnosing and managing glaucoma in children requires child-appropriate examination techniques, child-specific surgeries and medications, because infants and young children are not simply small adults. Families often bring their children from across the U.S. and other countries to seek care for their child’s glaucoma at Duke. Our goal is for your child to achieve the best vision possible, ideally normal or near-normal vision.
Choose Duke for management of your child’s glaucoma because we offer:
- Top-ranked care. U.S News & World Report consistently ranks Duke Eye Center among the nation’s best.
- Respected leaders. Our board-certified, fellowship-trained, glaucoma specialists and pediatric ophthalmologists travel internationally to lecture and teach courses on treating and managing childhood glaucoma. Our vast experience and knowledge means your child is cared for by some of the nation’s most respected glaucoma specialists.
- A team approach. Caring for children with glaucoma often requires a long-term team effort involving ophthalmologists, pediatricians, low vision educators, social workers, and other therapists. Glaucoma in children can affect other parts of the eye and cause vision loss from amblyopia, cornea scarring and strabismus. Our team specializes in treating these and other eye conditions in children.
- Latest treatment advances. We use the most advanced imaging technologies, and latest medical and surgical treatments to control glaucoma in children, and to manage other eye disorders often associated with childhood glaucoma.
- Compassionate, supportive environment. We offer patient and family support services, including educational materials and programs, a low vision rehabilitation program, and a dedicated social worker to help your child and your entire family cope with the management of your child’s glaucoma.
- Dedicated surgical suite. Our skilled surgeons work closely with anesthesiologists and surgical nurses who are trained and experienced in caring for children with eye conditions. We are expertly equipped to care for and treat complex and multiple eye problems including retinal and corneal diseases.
- Powerful imaging devices. Optical coherence tomography (OCT) offers 3-D views of the eye’s internal structures, including the retina and the optic nerve. Researchers in Duke’s Pediatric Retina and Optic Nerve Imaging Center are pioneering new uses for OCT, including the application of this non-invasive technology to the care of premature infant eye disorders.
- Promising research. We are studying advances in the diagnosis and treatment of childhood glaucoma using existing therapies. We also collaborate with specialists at Duke, and apply new technologies to the care of children with childhood glaucoma as soon as they are shown to be safe and effective.
Eye drops and oral medicine may be prescribed to help reduce eye pressure in pediatric glaucoma. Depending on your child’s needs, we will recommend one or a combination of medications to reduce eye pressure and minimize optic nerve damage.
These minimally invasive procedures, also called angle surgery, treat glaucoma by opening the pathway through which fluid flows out of the eye. (This is also called “the angle” and includes the trabecular meshwork and Schlemm canal). The procedures may control glaucoma for years in certain types of pediatric glaucoma, especially primary congenital glaucoma.
Also called “filtration surgery,” this procedure creates a small opening to bypass the natural pathway of fluid out of the eye. It works only in selected pediatric glaucoma cases because of a child’s natural tendency to heal closed a man-made opening in the eye wall.
An artificial (usually silicone or another type of plastic) drainage device is placed against the wall of the eye, and attached to a small tube which drains fluid from inside the eye to a reservoir around the device.
Laser energy is applied to the eye to decrease its ability to make fluid, which decreases eye pressure. This may be done from the outside of the eye through the eye wall, or endoscopically through a tiny incision. The endoscopic approach ensures a better view of the area within the eye that produces fluid.
While uncommon in children, this procedure may be helpful in cases where there is “narrow angle” glaucoma. (If the angle between the iris and the cornea is too small, the iris may bulge forward and block off the pathway for the fluid to reach the normal path to flow out of the eye.) A laser or surgical tool is used to create a small opening in the outside portion of the iris.
When childhood glaucoma occurs in conjunction with other eye disorders, a combination of surgeries may be performed. For example, a cataract may be removed at the same time that a glaucoma drainage implant is placed.
Your child’s glaucoma specialist will conduct a thorough examination of your child’s eyes. If your child is cooperative, the tests may be performed in the office. If your child cannot fully cooperate with the needed testing, they may be performed under anesthesia, and immediately followed by appropriate surgical treatment, if necessary.
Measures the eye pressure. Several devices may be used for this test, however, the newest instrument – the iCare rebound tonometer – has been extensively studied at the Duke Eye Center for its usefulness in evaluating children with known or suspected glaucoma. Because it does not require an eye drop to numb the eye before taking the eye pressure, this device is well suited for use in infants and children in the office.
Optical coherence tomography uses light to create a 3-D image of structures within the eye. Including the retina and optic nerve. The images are used to measure the thickness of the nerve fiber layer around the optic nerve so that it can be followed over time for damage from glaucoma. Since many children cannot cooperate with accurate testing of their peripheral vision, OCT provides a powerful tool for monitoring the health of the optic nerve in children with known or suspected glaucoma over time. Handheld OCT recently became available for use in the operating room, and may soon prove useful for evaluating optic nerve health in infants and children too young to have traditional imaging and peripheral vision testing.
Measures the peripheral vision (also called the visual field) in each eye. During the test, your child looks straight ahead while lights flash at various levels of brightness in their side vision. The test allows doctors to detect defects in the visual field. It is used to diagnose and determine the progression of glaucoma, but is only used in older children who can concentrate and whose central vision is good enough to fixate on the central target during testing.
A small contact lens is placed on the surface of the eye to view the outflow pathway (the “angle structures”) of the eye. This test can be done in the office, or during an examination under anesthesia for infants and young children. The detailed structure of the outflow pathway allows your doctor to determine the best surgical treatment for your child's glaucoma.
Sound waves measure the thickness of the cornea, the length of the eye, and create images of the vitreous, the retina, and glaucoma drainage implants (if they have been placed in an eye).