Dr. Nils Loewen presents a case of a 49-year-old glaucoma suspect referred by a Sam's Club optometrist. The patient presented with elevated IOP, large cups, and no vision complaints. He also had a significant family history of glaucoma. He was treated for presumed preperimetric glaucoma due to the relatively high risk of glaucoma. A change of structure (OCT) was not demonstrated during the time he was seen.