86 Predictors of glaucoma development in children with ocular hypertension

Objectives/Goals: Pediatric ocular hypertension (OHTN) carries a variable risk of glaucoma progression, yet its progression to true glaucoma is not well-defined. This study characterizes the clinical course of a cohort of pediatric eyes with OHTN and identifies predictors to glaucoma conversion. Methods/Study Population: A retrospective review of 119 eyes from 81 pediatric glaucoma suspects (IOP >21 mmHg on ≥2 visits) between 2005–2016. Conversion to glaucoma was defined by the Childhood Glaucoma Research Network criteria (progressive optic nerve cupping, visual field loss, or other structural changes associated with elevated IOP). Demographics, comorbidities, and tonometry methods were analyzed. Logistic regression identified independent risk factors for glaucoma conversion. Thus far, analyses include data from the 2005–2016 cohort, with additional data from the 2017–2023 patient cohort under collection and expected to be ready by the conference date. Results/Anticipated Results: Of 119eyes (age 9.4±4.7years; baseline IOP27.7±5.7mmHg), 47(39.5%) converted to glaucoma over average 1.9years.Among 72 non-converters, 23(31.9%) normalized without treatment, 17(23.6%) with treatment, 17(23.6%)remained elevated untreated, and 15(20.8%) with treatment. Conversion was most frequent with baseline IOP 24–28mmHg(16.0%)and less with <24mmHg(8.3%). Absence of ocular (11.8%vs50.6%) and systemic risk factors (36.0%vs48.5%) reduced conversion, lowering treatment need and improving normalization. On multivariable analysis, younger age (OR0.84/year, p=0.002), ocular risk factors (OR4.95,p=0.01), and time to therapy initiation (OR0.74/year, p<0.001) predicted conversion. Discussion/Significance of Impact: This study establishes baseline age and ocular risk factors as strong predictors of glaucoma conversion in pediatric ocular hypertensives. These findings are critical for clinicians, directly guiding an evidence-based approach to patient risk stratification, surveillance frequency, and treatment initiation.