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Glaucoma, Open Angle, Juvenile
Primary open angle glaucoma is a genetically and clinically heterogeneous condition. The type described here often has its onset in juveniles, much earlier than the usual type, and is much more rare. Onset is often in the second or third decade with an average age of onset of 18 years. It is rare for this form of POAG to be diagnosed after 40 years of age. IOP is commonly as high as 50 mmHg and the pressure is difficult to control. Glaucomatous changes in the optic nerve progress rapidly. The usual pharmacologic agents can be helpful early but surgical control is often required. Myopia is common (87%) but no anterior chamber anomalies are present. Juvenile POAG is more common in African Americans.
No systemic abnormalities have been reported.
Juvenile onset open angle glaucoma, GLAC1A, is inherited in an autosomal dominant pattern with high penetrance. It is caused by a mutation in MYOC located at 1q21-q31. The usual adult onset glaucoma is caused by different mutations.
The usual pharmacologic treatment may be effective in some, especially early, but eventually some form of filtration surgery is required in over 80% of patients.