Beyond Sight: Preserving Quality of Life in A Child With Advanced Juvenile Glaucoma and Severe Low Vision

Abstract

Introduction: Juvenile open-angle glaucoma (JOAG) is a rare but aggressive form of glaucoma that typically manifests in childhood or early adolescence. The condition is often resistant to medical therapy and leads to progressive visual impairment. Early diagnosis and appropriate intervention are important to preserve vision and improve long-term outcomes.
Case description: An 8-year-old girl presented with progressive vision loss in both eyes. She had a history of bilateral congenital cataract surgery and persistently elevated intraocular pressure (IOP) despite maximal topical anti-glaucoma therapy. The patient underwent glaucoma drainage implant (GDI) surgery in the right eye, which produced a significant and sustained reduction in IOP and prevented further visual deterioration in that eye. Despite a poor visual prognosis in the left eye, the patient achieved functional adaptation through low vision rehabilitation.
Discussion: JOAG is frequently associated with a strong genetic component and poses significant treatment challenges because of its aggressive progression. This case illustrates the limitations of pharmacological management and the role of timely surgical intervention. In addition, the integration of low vision rehabilitation and psychosocial support was essential in maintaining the patient's independence and quality of life.
Conclusion: This case shows the clinical challenges of managing JOAG in a pediatric patient with a complex ocular history. Surgical intervention, particularly the use of GDI, can be effective in cases refractory to medical management. Comprehensive care, including low vision support and psychosocial counseling, plays an important role in optimizing outcomes and quality of life in children with advanced glaucoma.