Childhood Glaucoma | Moorfields Eye Hospitals UAE

About Paediatric Glaucoma

Glaucoma is the name given to a group of eye conditions in which the pressure within the eye (intraocular pressure) is raised which in turn damages the optic nerve, (the nerve that goes from the eye to the brain) and can lead to permanent irreparable vision loss if left untreated.

Childhood glaucoma, also referred to as congenital glaucoma, paediatric, or infantile glaucoma, is a rare condition that may be inherited, occurring in babies and young children. It is usually diagnosed within the first year of life.

Causes

The eye is filled with a liquid like water that keeps the eyeball in shape. It helps keep the inside of the eye healthy by bringing nutrients and removing waste. The liquid is constantly being replaced by fresh liquid while the old liquid is removed from the eye through drainage channels. In majority of children with glaucoma, these drainage channels don’t function properly which results in the overflow of the liquid as the old does not drain and there is flow of new liquid to the eye. This leads the pressure inside the eye to increase. In most children, this is because the drainage channels haven’t formed properly as a baby.

Conditions Associated

Childhood glaucoma can occur as an isolated disease or it can be associated with other abnormalities of the eye or body. In patients with childhood glaucoma a thorough eye exam and questioning on child and family medical history are important. Communication with the paediatrician can also be useful in identifying other abnormalities.

Symptoms

The symptoms of childhood glaucoma can vary. In some cases, children will be asymptomatic; in other words, show no evident symptoms. In most cases, there will be a gradual onset of glaucoma related problems.
Some of the symptoms and signs of childhood glaucoma are:

Unusually large eyes
Excessive tearing
Cloudy eyes
Light sensitivity

Diagnosis

The diagnosis of childhood glaucoma is confirmed by carrying out a thorough eye examination by your eye doctor. The doctor will check the pressure of your child’s eye with different machines. The doctor will also check the health and structures of both eyes; this may require the use of some dilating eye drops. An assessment of your child’s vision will also be performed by an Orthoptist. Often, especially in very young children, an exam under anaesthesia (EUA) will be needed to provide additional information.

Treatments include either medical and surgical options or a combination of both.

Medical Treatment

Medical treatments involve the use of medicines. They can come in the form of topical eye drops and oral medications. These treatments help to either increase the removal of fluid from the eye or decrease the production of fluid inside the eye, resulting in decreased eye pressure. Side effects of these drugs must be considered and evaluated. In addition, parents should be carefully instructed in the administration of medicines, including any potential complications. Eye drops and oral medications may also be required after surgery.

Surgical Treatment

The decision to perform surgery and the type of surgery chosen will be based on the specific findings of your child’s eye examination. There are several types of glaucoma surgery, some of which use laser (detailed below). These will be discussed with your eye doctor. Some children may require more than one surgery to help control the glaucoma.

Goniotomy or Angle Surgery

This procedure involves going inside the eye and creating space so the liquid of the eye can drain outside. In order to perform this procedure, the front of the eye (cornea) has been to clear. The success rate can be variable; from 50-80%.

Glaucoma tube surgery

This surgery involves placing a device called Baerveldt tube or Ahmed Valve on the outer surface of the eye under the eyelid while the other part of the device goes inside the eye. This is a relatively complex procedure but works very well long term.

Cyclodiode laser

This involves applying laser from the outside of the eye to the organ that produces fluid in the eye. This procedure is relatively quick and effective but it is not long lasting. It can be repeated a few times.

After the surgery

Attending follow up appointments so your Ophthalmologist can check the success of the surgery is vital. Congenital glaucoma is a chronic conduction; often requiring multiple EUAs, glasses and in some cases multiple surgeries.

Paediatric Glaucoma Specialists

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Dubai
Abu Dhabi

Dr. Imran Jawaid

Consultant Ophthalmologist in Paediatric Ophthalmology and Strabismus surgery

Dr. Imran Jawaid is a Consultant Ophthalmologist, specialised in Paediatric Ophthalmology and Strabismus, at Moorfields Eye Hospital Dubai in Dubai Healthcare City. He holds a Bachelor of Medicine, Bachelor of Surgery (MBChB) degree in Medicine from the University of Leicester, School of Medicine, graduating with honours in 2010. He is also dual qualified as an Optometrist with a Bachelor of Science (HONS) degree in 2003. Dr. Imran has completed his Fellowship with the Royal College of Ophthalmologists (FRCOphth) and obtained his Certificate of Completion of Training (CCT) in Ophthalmology in 2020. Dr. Imran has more than 15 years of experience in Ophthalmology in the United Kingdom and has completed a post-CCT fellowship in Paediatric Ophthalmology and Strabismus at Birmingham Children’s Hospital, UK. Most recently he was a Consultant Ophthalmologist and Head of Service for Ophthalmology at Nottingham University Hospitals, NHS Trust, a large tertiary centre for ophthalmic referrals. He has undertaken research in myopia, visual impairment, diabetic macular oedema and emergency ophthalmology, amongst other areas and has published over 10 research papers in leading journals. In addition to his research, Dr. Imran is a keen educator and has taught at different UK medical schools and contributed to book chapters in Ophthalmology. He is a member of the Royal College of Ophthalmologists (FRCOphth) and is the recipient of several internationally acclaimed awards and recognitions.

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Dr. Salma Yassine

Specialist Ophthalmologist in Paediatric and Neuro-ophthalmology

Dr. Salma Yassine is a specialist ophthalmologist in paediatric and neuro-ophthalmology at Moorfields Eye Hospital Dubai in Healthcare City Dubai. She holds a bachelor’s in science (2012) with high distinction and a medical degree (2016) from the American University of Beirut. She finished Her ophthalmology residency at the American University of Beirut Medical Center in 2020 before pursuing a fellowship in neuro-ophthalmology at the University of Minnesota in 2021, followed by another fellowship in pediatric ophthalmology and strabismus at Children’s National Medical Center in Washington DC. She has international experience in paediatrics and neuro-ophthalmology in countries including the USA and Lebanon. She has practised in leading medical institutions such as the University of Minnesota and the Children’s National Medical Center in the US. She has researched intracranial hypertension and nanophthalmos and published research papers on nystagmus and nanophthalmos in leading journals. She is a member of the American Association for Pediatric Ophthalmology and Strabismus Association (AAPOS) The North American Neuro-Ophthalmology Society (NANOS), and the Lebanese Ophthalmological Society (LOS)

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Dr. Salman Waqar

Consultant Ophthalmologist in adult and paediatric glaucoma and cataract surgery

Dr. Salman Waqar is an experienced consultant ophthalmologist specialising in the treatment of adult and paediatric glaucoma and cataracts at Moorfields Eye Hospital Dubai in Dubai Healthcare City. His areas of expertise include medical, laser and surgical treatments for glaucoma (including minimally invasive implants and aqueous shunt devices). He also offers cataract surgery using the latest small incision technology, and with a range of intraocular lenses (Toric, Multifocal and Extended Depth of Field), tailored to the patients individual needs. Dr. Waqar graduated from Pakistan and has over 15 years’ experience of work in the United Kingdom. He holds a Certificate of Completion of Training from the UK, and is a Fellow of the Royal College of Ophthalmologists. He has worked in various prestigious eye units including the West of England Eye Unit (Exeter), where he completed his sub-specialty training in glaucoma. In his career, he has been appointed as a consultant across a wide range of leading medical institutions such as the Royal Eye Infirmary (Plymouth), Nuffield Health, Medical Eye Clinic and Newmedica. In addition to his clinical work, he has also performed with distinction as director of clinical governance and for the glaucoma service. Dr. Waqar’s research interests include optimizing patient outcomes with minimally invasive surgery, using virtual reality simulation to investigate surgeon performance and the development of innovative surgical instruments to improve patient safety. He has published extensively in peer-reviewed journals, such as the British Journal of Ophthalmology and the Journal of Cataract and refractive Surgery, and presents regularly at national and international meetings. He holds memberships with the United Kingdom and Eire Glaucoma Society, the European Society of Cataract and Refractive Surgeons and the American Academy of Ophthalmology. In his capacity as an Honorary Fellow with Plymouth University, he has been involved in training the doctors and surgeons of our future. In 2019, his work was recognized with a nomination for a regional Trainer of the Year Award by the Peninsula School of Ophthalmology. In addition, he has been the recipient of numerous research grants, and has co-authored two medical textbooks. Other accolades include invitations as a surgical skills instructor at minimally invasive glaucoma surgery courses, and to the microsurgical skills course with the Royal College of Ophthalmologists. In his spare time he is an avid reader, aspiring author and motivated triathlete.

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Dr. Suhair Twaij

Consultant Ophthalmologist in Adult & Paediatric Strabismus Surgery, Paediatric Ophthalmology, Adult Cataract Surgery

Dr. Suhair Twaij is a Consultant Ophthalmologist with a subspecialist interest in adult and paediatric Strabismus surgery, Paediatric Ophthalmology, adult Cataract Surgery and General Ophthalmology at Moorfields Eye Hospital Dubai. Dr. Twaij recently relocated to the UAE from the UK, where she has worked as a consultant ophthalmologist at the Royal Victoria Hospital in Belfast since 2013. She was also the clinical lead for the adult motility service in Northern Ireland from 2014. She holds a graduate degree in medicine from the Baghdad University Medical School, obtained in 1994. Her areas of expertise include complex adult and paediatric squint surgery using the adjustable technique when needed, double vision correction, adult cataract surgery with an implant, Botox treatment for squints, double vision, blepharospasm and aesthetics. She has over 20 years of experience in general ophthalmology, including cataract surgery, anterior and posterior segments such as glaucoma and diabetic retinopathy. Dr. Suhair trained in the UK from 2004 in England and Northern Ireland and was awarded the certificate of completion of training (CCT) in ophthalmology in the UK in 2012. She was awarded the Royal College of Ophthalmologists Fellowship in the same year. Throughout her career, she has practised in leading medical institutions such as The Royal Victoria Hospital in Belfast, Northern Ireland, Altnagelvin Area Hospital, Northern Ireland, The Bristol Eye Hospital, England, and King Hussein Medical City Amman, Jordan. Dr. Suhair is an avid researcher and has Medline-published papers in various ophthalmology topics such as medical retina, paediatric ophthalmology and oculoplastics. She is a member of the Royal College of Ophthalmologists, the British & Irish Paediatric Ophthalmology and Strabismus Association (BIPOSA) and the European Association of Strabismus (ESA).

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Dr. Alaa Bou Ghannam

Visiting Specialist Ophthalmologist in Neuro-Ophthalmology, Paediatric Ophthalmology, Paediatric Glaucoma & Adult Strabismus

Dr. Alaa Bou Ghannam is a visiting specialist in neuro-ophthalmology, paediatric ophthalmology, and adult strabismus at Moorfields Eye Hospital Dubai in Dubai Healthcare City. He holds a bachelor in science (2007) with high distinction and a medical degree (2011) from the American University of Beirut. He finished his ophthalmology residency at the American University of Beirut Medical Center in 2015 before pursuing a fellowship in pediatric ophthalmology and adult strabismus from Children's National Health System and George Washington Hospital in Washington DC in 2016. He also finished another fellowship in neuro-ophthalmology from The University of Colorado in 2017. He has over five years of regional/international experience in paediatric ophthalmology, adult strabismus, and neuro-ophthalmology in countries including Lebanon and The United States of America. In his career, he has practiced in leading medical institutions such as The American University of Beirut Medical Center. He has undertaken research in clinical ophthalmology and neurology and has published more than a dozen research papers and book chapters on strabismus, optic nerve diseases, paediatric glaucoma, paediatric ophthalmology, ocular electrophysiology, and nystagmus, in leading medical journals. He is a member of the American Academy of Ophthalmology (AAO), Lebanese Ophthalmological Society (LOS), North American Neuro-ophthalmology Society (NANOS), and The American Association for Pediatric Ophthalmology and Strabismus (AAPOS).

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