By the American Academy of Ophthalmology Preferred Practice Pattern Glaucoma Panel: Bruce E. Prum, Jr., MD,1 Lisa F. Rosenberg, MD,2 Steven J. Gedde, MD,3 Steven L. Mansberger, MD, MPH,4 Joshua D. Stein, MD, MS,5 Sayoko E. Moroi, MD, PhD,6 Leon W. Herndon, Jr., MD,7 Michele C. Lim, MD,8 Ruth D. Williams, MD9
As of November 2015, the PPPs are initially published online-only in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the journal's PPP Collection page.
A very limited update to this PPP was published in Ophthalmology in June 2018.
1 Department of Ophthalmology, University of Virginia Health System, Charlottesville, Virginia
2 Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
3 Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
4 Legacy Devers Eye Institute, Portland, Oregon
5 W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
6 W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
7 Duke Eye Center, Duke University Medical Center, Durham, North Carolina
8 UC Davis Eye Center, University of California, Davis, Sacramento, California
9 Wheaton Eye Clinic, Wheaton, Illinois
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
Established and important risk factors for primary open-angle glaucoma (POAG) include age, race/ethnicity, level of intraocular pressure (IOP), family history of glaucoma, low ocular perfusion pressure, type 2 diabetes mellitus, myopia, and thin central cornea.
Primary open-angle glaucoma with consistently normal IOP is common, especially in certain populations. Lowering pressure in these patients can be beneficial.
Characteristic clinical features of POAG include an open angle on gonioscopy, and glaucomatous optic nerve head (ONH) and retinal nerve fiber layer (RNFL) changes that usually are associated with typical glaucomatous visual field defects.
Computer-based imaging and stereoscopic photography provide different and complementary information about optic nerve status and are useful adjuncts to a good clinical examination.
Adjusting computerized visual field programs (24 degrees, 30 degrees, 10 degrees) and varying stimulus size for patients with advanced glaucoma aid in detecting and monitoring progressive visual field loss.
Clinical trials have shown that lowering IOP reduces the risk of developing POAG and slows the progression of POAG, including normal-tension OAG.
Effective medical, laser, and incisional surgical approaches exist for lowering IOP.
A reasonable initial treatment in a POAG patient is to reduce IOP 20%–30% below baseline and to adjust up or down as indicated by disease course and severity.