Case - 14 year old girl

[Richard_Hom]

Let's say hypothethically, a 14 year old girl presents for the first time for a "routine eye examination". She has seen several community providers in the past 5-6 years for spectacle correction. She is asymptomatic and her personal and familial general and ophthalmic histories are unrelated.

Hypothetically, her examination shows that her IOP's are consistently in the high 20's either in mid-morning or mid afternoon over a 3-day period. Her optic nerve cupping is 0.95 in each eye with "bean pot" excavation. The neuro retinal rims are "thin". The pallor appears to be normal in each disc.

Threshold 24-2 shows arcuate scotomas superiorly and inferiorly in either eye with good gaze tracking and 0/11 fixation losses.

Clnical impression: Glaucoma

In this hypothetical case, a consulting comprehensive ophthalmologist has recommended a referral to a pediatric ophthalmologist rather than a glaucoma subspecialist. What are your thoughts and why would you choose one over the other?

Regards,
Richard

---

Members don't see this ad.

 

[Retinamark]

I'd go with the glaucoma sub-specialist. 14 is old enough to co-operate with most things & she will need surgery. If that was my daughter, I'd want her to have the surgery done by someone who does glaucoma surgery all the time, not someone who does squint surgery all the time, with the occasional trab.
Having said that, there are plenty of pediatric ophthalmologists in my city who would do a good job.

 

[Andrew_Doan]

I'd go with the glaucoma sub-specialist. 14 is old enough to co-operate with most things & she will need surgery. If that was my daughter, I'd want her to have the surgery done by someone who does glaucoma surgery all the time, not someone who does squint surgery all the time, with the occasional trab.
Having said that, there are plenty of pediatric ophthalmologists in my city who would do a good job.

I agree. Glaucoma specialist.

 

[IdiotBoxen]

Hypothetically, I'd say the glaucoma specialist. At 14, the pt is probably old enough to manage it.

Only thing i'd worry about is post op compliance...

 

[golgi]

I think it would be a crime not to refer her to a glaucoma specialist for w/u of juvenile glaucoma.