Evolving Perspectives on Congenital Glaucoma

Congenital glaucoma differs from adult glaucoma in that it represents a panocular disorder defined by structural, functional, and physiologic parameters. In order to achieve excellent visual outcomes, the management of congenital glaucoma involves concurrently controlling intraocular pressure and treating amblyopia, while minimizing any influence of a compromised visual axis. Thus far, difficulty in assessing visual function in pre-verbal children has resulted in a paucity of long-term visual outcome data. However, based on commonly recognized obstacles to structural/physiologic stability and functional rehabilitation status, we propose a congenital glaucoma severity scale in order to provide a cross-sectional stratification of disease severity. As the severity of pathology evolves over time, the severity score should be adjusted accordingly. The initial score and rate of changes in severity (“severity slope”) will help in prognosticating outcome. Future studies will be required to validate, calibrate, and discriminate this severity scale before clinical and research applications