40 EyeWorld Asia-Pacific | June 2025 ASIA-PACIFIC PERSPECTIVES It is an honor to contribute my reflections on the article “Identifying and Managing Steroid-Induced Glaucoma.” This topic is of particular importance, especially given the increasing use of corticosteroids in both adult and pediatric populations. Diagnostic Challenges in Pediatric Patients Detecting steroid-induced glaucoma is particularly challenging in young children who require long-term corticosteroid therapy, such as those with chronic allergic conditions. This patient group requires especially vigilant monitoring, as they may not be able to verbalize their symptoms. Early signs—such as subtle blurring of vision, halos around lights, or microcystic corneal edema—may go unnoticed or be misinterpreted. These subtle indicators may be the only clues to elevated intraocular pressure in children who are otherwise unable to describe visual disturbances. Manchima MAKORNWATTANA, MD Associate Professor, Department of Ophthalmology, Thammasat University, Thailand, Paholyothin, Pathumtani manchima123@yahoo.com Considering Historical Steroid Exposure There are cases where patients present with optic neuropathy or visual field defects without a definitive pathological finding. When current examination does not reveal active glaucomatous damage or ongoing steroid use, it is important to consider prior corticosteroid exposure as a possible etiology. Although the disease may no longer be actively progressing, residual structural or functional deficits from past steroid-induced damage may persist. In such scenarios, over-treatment should be avoided. A careful history is essential to identify prior steroid misuse. While ophthalmologic evaluation remains important, routine referral may not be necessary if there is no ongoing risk. Patient education on the potential risks of steroid use remains a key component of preventive care. Editors’ note: Dr. Manchima Makornwattana disclosed no relevant financial interests. About the Physicians Rebecca Chen, MD | Assistant Professor, Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California | rebeccaichen@gmail.com Malik Y. Kahook, MD | Professor and Vice Chair, Department of Ophthalmology, Slater Family Endowed Chair in Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado | malik.kahook@gmail.com Robert Noecker, MD, MBA | Ophthalmic Consultants of Connecticut, Fairfield, Connecticut | noeckerrj@gmail.com Relevant Disclosures Chen: None Kahook: Alcon, FCI, New World Medical, SpyGlass Pharma Noecker: None This article originally appeared in the March 2025 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
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