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
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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.