Primary Open-Angle Glaucoma Suspect PPP 2020

By the American Academy of Ophthalmology Preferred Practice Pattern Glaucoma Committee: Steven J. Gedde, MD,¹ John T. Lind, MD², Martha M. Wright, MD,³ Philip P. Chen, MD,⁴ Kelly W. Muir, MD,⁵ Kateki Vinod, MD,⁶ Tianjing Li, MD, MHS, PhD,⁷ Steven L. Mansberger, MD, MPH⁸

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 PPP on the journal's site. Click here to access the journal's PPP collection page.

As of May 2021, a correction has been issued for the Primary Open-Angle Glaucoma Suspect PPP. Open the PDF for the corrections here or click here to access the correction on the journal's website.

¹Bascom Palmer Eye Institute, Miami, Florida

²Indiana University School of Medicine, Department of Ophthalmology, Indiana, Indianapolis

³Minneapolis VA Medical Center, Minneapolis, Minnesota

⁴Professor and Grace E. Hill Chair, Department of Ophthalmology, University of Washington, Chief of Ophthalmology, UW Medicine Eye Institute, Seattle, Washington

⁵Duke University School of Medicine, Department of Ophthalmology, Durham, North Carolina

⁶Department of Ophthalmology, Icahn School of Medicine at Mount Sinai and Eye and Ear Infirmary of Mount Sinai, New York, New York

⁷Associate Professor, Department of Ophthalmology, School of Medicine, Department of Epidemiology, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado

⁸Legacy Devers Eye Institute, Portland, Oregon

Highlighted Findings and Recommendations for Care

A diagnosis of primary open-angle glaucoma (POAG) suspect is established by the presence of a consistently elevated intraocular pressure (IOP), also known as ocular hypertension, or a suspicious optic nerve, retinal nerve fiber layer (RNFL), or visual field, in one or both eyes.

Established risk factors for POAG include older age, African race or Latino/Hispanic ethnicity, elevated IOP, family history of glaucoma, low ocular perfusion pressure, type 2 diabetes mellitus, myopia, and a thin central cornea.

The decision to treat a POAG suspect patient depends on the level of IOP and other associated risk factors, or evidence of change of the optic nerve, RNFL, or visual field indicating the development of POAG.

In the Ocular Hypertension Treatment Study (OHTS), more than 90% of patients with untreated ocular hypertension did not progress to glaucoma over 5 years, but treatment to lower IOP reduced the risk of developing POAG from 9.5% to 4.5%.

A reasonable target for IOP reduction in a POAG suspect patient in whom the decision to treat has been made is 20% based on the OHTS.

Appropriate testing to evaluate and monitor patients diagnosed as glaucoma suspect includes gonioscopy, pachymetry, tonometry, perimetry, careful examination of the optic nerve, and ocular imaging. Computer-based imaging and stereoscopic photography provide different and complementary information about optic nerve status.

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