Keratoconus is an ectatic corneal disease characterized by progressive stromal thinning, irregular astigmatism and defective vision. It can be unilateral or bilateral with asymmetric presentation. It starts at puberty and either progresses rapidly to an advanced stage of the disease or stops in case of delayed onset and slow progression. Pediatric keratoconus is more aggressive than in adults and the management protocols differ because of various rationales such as accelerated progression, advanced stage of disease at the time of diagnosis and co-morbidities. It poses a burden to society as it affects the quality of life, and social and educational development in children. Hence, early diagnosis, recognition of progression and timely intervention with collagen crosslinking is imperative to arrest the worsening. Association with systemic syndromes and ocular comorbidities can be of concern in pediatric keratoconus. Severe ocular allergy when associated hastens progress and complicates timely intervention of crosslinking treatment and compliance to contact lens wear. Keratoplasty in pediatric keratoconus has good outcomes but can encounter frequent suture-related concerns. This article discussed the epidemiology, etiopathogenesis, clinical challenges and current perspectives of management of pediatric keratoconus.

A retrospective analysis was conducted of all consecutive pediatric patients diagnosed and operated on for bilateral congenital cataracts during a seven-year period (2012 to 2018) in rural southern Ethiopia. Intraocular pressure and visual acuity before and after pediatric congenital cataract surgery performed at a relatively older age was assessed. Non-ambulatory vision was defined as hand motion or worse. The main outcome measures were intraocular pressure (IOP) and visual acuity.

Thirty-two children were included, 17 females (53.1%), with a mean age of 11 years (± 2.83) [range, 7 to 18]. A total of 59 eyes were operated on. The mean follow-up was 4.8 ± 1.8 years (range, 2 to 8). VA improved from 20/1400 preoperatively to 20/440 postoperatively OD and 20/540 OS. More eyes had ambulatory vision after cataract surgery than pre-surgery (56 eyes [95%] vs. 29 eyes [49%]. The IOP decreased from a mean preoperative value of 18.4 ± 7.1 mmHg to 14.5 ± 2.9 postoperatively OD, and 16.3 ± 5.9 mmHg to 13.9 ± 3.5 OS. Fifteen eyes (24%) had increased IOP (> 21 mmHg) preoperatively, of which three remained high after surgery. Positive correlations were found between IOP, axial length and cup-to-disc ratio. None of the patients required pressure-lowering procedures.

Researchers wrote that bilateral congenital cataracts may be associated with ocular hypertension, with possible progression to glaucoma if left untreated. They added that, in this study, surgery at a relatively older age often was associated with a significant improvement in intraocular pressure and ambulatory vision.

These researchers evaluated the driving performance in young and middle-aged Chinese glaucoma patients with mild to severe visual field loss compared to those without glaucoma by using a driving simulation test. Twenty-nine participants were included in this study: nine patients with glaucoma that passed the binocular Esterman visual field test, 10 patients with glaucoma that failed the binocular Esterman visual field test, and 10 age-matched healthy controls. A driving simulation test was designed as a frequency-based analysis of a lane-keeping task. The total performance error, the control-response amplitude and delay were calculated.

The failing Esterman visual field test group showed the longest delay of control-response among the three groups. And a lane-keeping task delay was significantly associated with the inferior field of better-eye (r=0.51) and integrated visual field (r=0.55).

Young and middle-aged glaucoma patients with binocular visual field loss exhibited a longer delay of response in the driving simulation test, while the inferior visual field had a greater impact on performance than the superior visual field.