Elevated Risk and Severity of Juvenile Open-Angle Glaucoma in Children with Neurodevelopmental Disorders

ORCID

0009-0001-6515-011X (Foster)

Document Type

Article

Publication Date

2026

Publication Title

Investigative Ophthalmology & Visual Science

Volume

67

Issue

7

Pages

4210

Abstract

Purpose: Neurodevelopmental disorders (NDDs) are common in childhood and have been associated with abnormalities in ocular motility and visual processing. Whether NDDs are also associated with an increased risk of more severe optic nerve disease, such as juvenile open-angle glaucoma (JOAG), remains poorly characterized. This study evaluated the association between NDDs and incident JOAG in a large pediatric population. A secondary aim was to determine whether children with both NDDs and JOAG exhibit greater disease severity compared with children with JOAG but without NDDs.

Methods: We conducted a retrospective cohort study using the TriNetX Global Research Network. Children aged 5–18 years with neurodevelopmental disorders were identified and compared with age-eligible children without NDDs. Propensity score matching (PSM) on age, sex, and race was performed to create balanced cohorts. The primary outcome was the risk difference (RD) for incident JOAG. A secondary analysis compared children with JOAG + NDDs to those with JOAG alone. Severity was assessed by comparing rates of glaucoma medication use (prostaglandin analogs, beta-blockers, carbonic anhydrase inhibitors), glaucoma surgery, and ED visits.

Results: A total of 854,222 children with NDDs and 854,222 without NDDs were included. JOAG incidence was higher in the NDD cohort (0.007% vs 0.004%; p = 0.0018; RR = 1.97; OR = 1.97).

Among JOAG cases, 133 children with NDDs were matched to 133 without NDDs. Prostaglandin analog use was higher in the NDD group (RD = 16.54%; p = 0.007; RR = 1.45; OR = 1.96). Beta-blocker use was similarly increased (RD = 15.04%; p = 0.013; RR = 1.44; OR = 1.86), as was carbonic anhydrase inhibitor use (RD = 15.31%; ; p = 0.013; RR = 1.42; OR = 1.85). Disease severity markers were also higher in NDD patients. ED utilization increased (RD = 19.55%; p = 0.0013; RR = 1.43; OR = 2.23), and surgical intervention was more common (RD = 10.53%; p = 0.042; RR = 1.59; OR = 1.82). Overall, children with NDDs demonstrated consistently greater JOAG severity.

Conclusions: Children with neurodevelopmental disorders had a significantly higher incidence of JOAG compared to neurotypical children. In conjunction with this result, the elevated medication, ED, and surgical burden reflects greater JOAG severity among children with NDDs. These findings support the need for heightened clinical vigilance for JOAG in children with NDDs.

Original Publication Citation

Belday, K., Desai, D., Arnold, K., Foster, M., & Orge, F. (2026). Elevated risk and severity of juvenile open-angle glaucoma in children with neurodevelopmental disorders. Investigative Ophthalmology & Visual Science, 67(7), 4210. https://iovs.arvojournals.org/article.aspx?articleid=2816935

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