HEALTH MATTERS: Toddler develops — and overcomes — childhood glaucoma

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The thought that a child could be affected by glaucoma can be frightening.

Sebrina Cardoza thought her 3-month-old daughter Meagan Charles was just suffering from allergies.

“Her eyes were getting larger, frequently watery and were sensitive to the light,” Cardoza said. “After seeing three specialists, I found out it was glaucoma and never thought my baby could get that disease.”

The reality is everyone is at risk of glaucoma, from infants to senior citizens.

January is Glaucoma Awareness Month to inform the public about what is known as the “silent thief of sight” and share risk factors, treatment and the latest research about an eye disease that is one of the leading causes of vision loss in the United States. There is no cure for glaucoma, and glaucoma-related vision loss is irreversible.

Glaucoma, which is damage to the optic nerve, is usually associated with the aging population. Older people are at a higher risk for glaucoma.

“In fact, childhood glaucoma occurs in 1 in 10,000 live births and more commonly affects males about 70 percent of the time,” said Dr. Joseph Panarelli, a glaucoma surgeon at New York Eye and Ear Infirmary of Mount Sinai. “It can be present at birth or occur within a child’s first year, when the drainage canal has not developed properly, trapping fluid in the eye, causing it to expand and bulge.”

Glaucoma is challenging to diagnose as well as treat. Estimates put the total number of suspected cases of glaucoma at over 60 million worldwide.

Prevent Blindness America estimates that more than 3 million Americans have glaucoma but only half of those know they have it. The best way to protect your sight from glaucoma is to get tested.

“Though primary congenital glaucoma is rare, there are many congenital ocular abnormalities as well as systemic conditions that are associated with glaucoma in children,” Dr. Panarelli said. “There is a genetic link to this disease and new genes continue to be identified.”

Dr. Panarelli says that careful observation of a child’s eyes are essential.

“Parents and pediatricians should become suspicious if they notice a child’s eyes are becoming progressively large and/or the front of the eye becomes cloudy,” he said. “Children will often begin to tear and become sensitive to light as this happens.”

The risk for glaucoma increases after the age of 40. African Americans and Hispanics are more likely than Caucasians to be diagnosed with glaucoma. Other risk factors include diabetes, eye injuries, eye tumors, a family history of the disease or the use of corticosteroids

Childhood glaucoma often results from poor development of the drainage canal.

“It’s not a condition pediatricians normally check for and there are few ophthalmologists who feel comfortable doing the corrective surgery on infants,” Dr. Panarelli said. “But if done right, it’s completely reversible.”

High pressure in developing eyes can lead to optic nerve damage, corneal damage, progressive myopia and amblyopia. Early pressure-induced changes on the optic nerve can be reversed and permanent damage prevented.

“Meagan’s intraocular pressure was 54 mm Hg in both eyes when she presented,” Dr. Panarelli said. “The normal intracular pressure for children and adults is 10-21 mm Hg.”

Childhood glaucoma often results from poor development of the drainage canal.
(Infographics source: Animated Dissection of Anatomy for Medicine)

“Most of the resistance is at the inner wall, so if we can clear those channels up, we can cure the disease,” he added. “It’s one of the few times, where as a glaucoma specialist we can actually fix the problem definitively.”

As an infant, Meagan had surgery on both her eyes before the damage got too bad.

“If the eyes grows too big, too fast they’ll develop a lot of troubles with developing good vision in the eye,” Dr. Panarelli said. “They develop astigmatism from the breaks in the cornea and they become very, very nearsighted, because the eyes are so long. And if the eyes are asymmetric, the brain doesn’t learn how to use both eyes together.”

To correct Meagan’s problem, Dr. Panarelli performed a 360-degree trabeculotomy with the iScience microcatheter, a treatment performed in only a few eye centers nationwide. Using the illuminated, flexible microcatheter, the surgeon was able to open the entire length of the Schlemm’s canal. The illuminated red diode indicator of the probe tip alleviates the problem of the “blind pass” and avoids the potential complications resulting from misdirection of the catheter.

It also features a central channel for injecting viscoelastic agents to expand the canal during catheter advancement. The procedure takes approximately 30-45 minutes to perform.

The Glaucoma Research Foundation reports that another option is stem cells treatment, which is still in the early stages, to replace degenerated ocular tissues — the trabecular meshwork, which composes the drain of the eye and regulates intraocular pressure, and the optic nerve, which transmits visual information from the eye to the brain.

“We were very confident about the physician’s capability to help our daughter,” Cardoza said. A week after the surgery, Meagan’s eyes showed a marked improvement. Her corneas were clear, the changes in the optic nerves were reversed, and her intraocular pressure dropped to 12 mm Hg in both eyes.

“Pediatric glaucoma is one of the most challenging conditions that I treat, but it is also one of the most rewarding aspects of my practice,” Dr. Panarelli said. “I feel privileged to be able to help restore sight to children at a crucial stage in their intellectual and social development.”

Meagan’s vision was saved due to her parents’ early detection and quick action, along with the ground-breaking surgical procedure performed by Dr. Panarelli.

She did not need additional surgeries, only check-ups are required every three months. She is almost 2 years old.

 

Resources:

Alliance for Eye and Vision Research – www.eyeresearch.org

Centers for Disease Control and Prevention – www.cdc.gov

Glaucoma Research Foundation – www.glaucoma.org

New York Eye and Ear Infirmary of Mount Sinai – www.nyee.edu

Your Sight Matters – www.yoursightmatters.com

National Eye Institute – www.nei.nih.gov

Marie Y. Lemelle, MBA, a public relations consultant, is the owner of Platinum Star PR and can be reached on Twitter @PlatinumStar or Instagram @PlatinumStarPR. Send “Health Matters” related questions to healthmatters@wavepublication.com and look for her column in The Wave.

 

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