juvenile glaucoma

Juvenile Glaucoma

Prof. Bernhard Sabel

„The optimization of residual vision is a holistic complement to ophthalmological care such as eye drops or surgeries. We continue where ophthalmology stops. We combine conventional medical science with new findings from modern brain research and traditional medicine methods.“

What is juvenile glaucoma?

Glaucoma is actually considered a disease of the elderly, but there is also a juvenile form, even if it is rather rare. According to the Gutenberg Health Study, it only affects one in around 44,000 people. In juvenile glaucoma, the intraocular pressure increases between the ages of 10 and 35. Patients are on average 18 years old at the time of diagnosis.

The increased pressure inside the eye occurs when the intraocular pressure and the blood flow to the optic nerve are no longer in balance. For example, as soon as the pores of the drainage tubules tighten, the intraocular pressure increases and too much fluid accumulates in the eye. At the same time, the blood flow in the optic disc decreases. Too much pressure reduces the blood flow and damages the optic nerve, impairing vision in the long term.

Glaucoma is one of the most common causes of blindness worldwide. In Germany alone, around 500,000 people suffer from glaucoma, although experts estimate that the number of unreported cases is much higher. Around a tenth of all sufferers go blind.

The causes of juvenile glaucoma

Juvenile glaucoma is probably genetic: Doctors have identified mutations in the CYP1B1 and MYOC genes. However, parents do not always inherit this disease: in some children, glaucoma develops for no known reason.

Whether inherited or not, juvenile glaucoma occurs when the aqueous humor in the eye can no longer drain properly. However, the resulting pressure only occurs once the drainage system in the eye has matured. This means that the intraocular pressure may still be normal in the first few years of a child’s life, but slowly increases over the course of childhood.

How can I tell if my child has juvenile glaucoma?

Juvenile glaucoma is often discovered by chance during a routine examination, as it does not initially cause any problems. However, this changes as the disease progresses. The vision of those affected is considerably reduced and the field of vision narrows. Things in the center of the field of vision can still be seen clearly, but everything in the periphery, i.e. outside, remains hidden. As a result, spatial perception is so limited that climbing stairs or participating in road traffic becomes dangerous.

How is juvenile glaucoma diagnosed?

If a child starts to experience eye problems, it is important to see a doctor immediately. This is the only way to prevent the intraocular pressure from slowly increasing and eventually damaging the optic nerve. Early diagnosis can prevent blindness.

The most important diagnostic steps are the measurement of the corneal diameter (vertical and horizontal) and pachymetry, i.e. the measurement of the corneal thickness.

Tonometry is a measurement of intraocular pressure, which can, however, be incorrect, especially in young children. This applies to both awake and anaesthetized children. However, there are other tonometric procedures such as rebound tonometry or applanation tonometry, which can also be used for diagnosis.

During an ophthalmoscopy, doctors examine the eyes with an ophthalmoscope. This is a special microscope with a light source that greatly magnifies the eye. This allows ophthalmologists to clearly see the structures and changes in the eye.

During an ultrasound examination (sonography), doctors measure the length of the eyeballs. Gonioscopy can be used to examine the chamber angle. In older children, a visual field measurement (perimetry) can also be carried out. A restricted field of vision can be detected in children from the age of six. In addition to all these examinations, doctors also carry out an eye test, which may provide evidence of short-sightedness.

Progression of juvenile glaucoma

Both the course and the prognosis vary from person to person. They depend crucially on when the disease was diagnosed and how quickly it was treated. As with almost all diseases, the same applies here: The earlier it starts, the more favorable the course.

If the optic nerve has not yet been damaged, blindness can be prevented. If juvenile glaucoma is treated successfully, eye pressure and visual field remain stable in adulthood.

How can SAVIR therapy help with juvenile glaucoma?

If the optic nerve is already damaged, patients’ visual performance can be improved with the help of SAVIR therapy. This has been confirmed by a clinical study. Small microcurrent impulses reactivate paralyzed nerve cells and improve blood flow so that it can better process the remaining visual stimuli. This alternating current treatment can significantly improve the vision of patients suffering from glaucoma.

In the study, 82 patients whose visual performance was impaired due to damage to the optic nerve were treated for ten days with either alternating current (SAVIR therapy) or a placebo therapy without current. For the alternating current treatment, electrodes were positioned above and next to the eyes and the patients were administered very light current pulses via the electrodes for 40 minutes each day.

After just ten days of alternating current therapy, the visual performance of two thirds of the study participants improved significantly, as the neuron network in the eyes and brains of the visually impaired people was reconnected. The blood flow to the brain also improved. For example, the visual cortex in the back of the head was once again able to exchange signals with the frontal cortex in the forehead. As a result, the patients were able to see better again.

Risks and side effects of SAVIR therapy for juvenile glaucoma

The risks and side effects of SAVIR therapy are not yet known. The current pulses used are so weak that they can hardly be felt on the skin. Patients may notice brief flashes of light when their eyes are closed during treatment.

Incidentally, the current pulses are significantly lower than those of a pacemaker. There are no known undesirable side effects. But the chances of recovery are good.

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