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Expert Interview Glaucoma Glaucoma Pediatric Corneal Disease—Special Considerations An Expert Interview with Gerald W Zaidman Professor of Clinical Ophthalmology, Director of the Cornea Service, and Vice-Chairman and Director of the Department of Ophthalmology, New York Medical College, Westchester Medical Center, New York, New York, US Gerald W Zaidman Dr Gerald W Zaidman is Professor of Clinical Ophthalmology, Director of the Cornea Service, and Vice-Chairman and Director of the Department of Ophthalmology at the New York Medical College, Westchester Medical Center. Dr Zaidman has published over 50 peer- reviewed articles and has presented at numerous meetings as a named lecturer on issues pertaining to cornea/external diseases, keratorefractive surgery, and pediatric corneal diseases. He has received both an honor award and a senior honor award from the American Academy of Ophthalmology. He has received seven research grants. He has traveled to many regions of the United States, Europe, and Asia as an invited guest lecturer. He has extensive experience in laser vision correction and corneal transplant surgery and has lectured at and moderated many national eye meetings. He is on the editorial board of the Journal of Pediatric Ophthalmology and Strabismus and is a reviewer for all the major journals in ophthalmology. Dr Zaidman is the founder and president of the Pediatric Keratoplasty Association.Through this society, Dr Zaidman has organized and promoted pediatric keratoplasty, an area of extreme difficulty and complexity. Keywords Pediatric glaucoma, pediatric corneal diseases, post-keratoplasty Disclosure: Gerald W Zaidman has nothing to disclose in relation to this article. No funding was received in the publication of this article. This is an expert interview and as such has not undergone the journal's standard peer review process. Acknowledgements: Gerald Zaidman would like to thank Dr Miriam Habiel for her help and assistance on this article. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: October 6, 2016 Published Online: April 10, 2017 Citation: US Ophthalmic Review, 2017;10(1):17–8 Corresponding Author: Gerald W Zaidman, 40 Saw Mill River Rd, Hawthorne, NY 10532, US. E: G laucoma is a frequent occurrence in pediatric corneal disease, and its management requires special considerations. This expert interview with Gerald W Zaidman will consider the definition, incidence, diagnosis and treatment of pediatric glaucoma, with the exception of congenital glaucoma, which is not a disease of the cornea. Q: How do we define pediatric glaucoma? The pediatric age group is defined as children under the age of 16. However, older children can usually be examined without difficulty; therefore, for the sake of our discussion we will focus on children under the age of 6 years old. In the ophthalmic literature, glaucoma specialists have presented varying definitions of pediatric glaucoma. Dr Paul Sidotti, when he lectured us, said that “glaucoma in children is a disease of elevated intraocular pressure with resulting damage to the optic nerve.” In their lectures, Drs Jeff Liebmann and Robert Ritch have observed that children tolerate a higher intraocular pressure than adults. Other pediatric glaucoma specialists look for increasing axial length or increased corneal diameter. This phenomenon is not seen in adults. But in young children there can be pressure-induced expansion of the globe prior to damage of intraocular structures. Therefore, is glaucoma in children a disease of increased intraocular pressure, changes in the optic nerve, a disease of increasing axial length, or a disease of increasing corneal diameter? Recently, in a monograph published after the World Congress on Childhood Glaucoma, 1 the consensus was that children must have at least two or more of the following: chronically elevated intraocular pressure greater than 21 mmHg (and typically in the higher 20s in order to create some of the other ocular changes seen in glaucoma); an increased cup-to-disc ratio or progressive cupping; an increase in corneal diameter, and an increase in axial length or a myopic shift on refraction. If a child demonstrates two of these findings, then they have pediatric glaucoma. Q: Which pediatric corneal diseases are likely to have glaucoma? One can categorize pediatric corneal diseases into three groups—congenital diseases, acquired traumatic diseases and acquired non-traumatic diseases. Congenital diseases, such as Peters’ anomaly, sclerocornea, congenital hereditary endothelial dystrophy, or congenital glaucoma make up 70% of all pediatric corneal diseases. Within the congenital disorders, 70% are due to anterior segment dysgenesis, and the rest are split between glaucoma and congenital hereditary endothelial TOU CH MED ICA L MEDIA 17