By the American Academy of Ophthalmology Preferred Practice Pattern Glaucoma Panel: Bruce E. Prum, Jr., MD,1 Michele C. Lim, MD,2 Steven L. Mansberger, MD, MPH,3 Joshua D. Stein, MD, MS,4 Sayoko E. Moroi, MD, PhD,5 Steven J. Gedde, MD,6 Leon W. Herndon, Jr., MD,7 Lisa F. Rosenberg, MD,8 Ruth D. Williams, MD9
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1 Department of Ophthalmology, University of Virginia Health System, Charlottesville, Virginia
2 UC Davis Eye Center, University of California, Davis, Sacramento, California
3 Legacy Devers Eye Institute, Portland, Oregon
4 W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
5 W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
6 Bascom Palmer Eye Institute, University of Miami, Miami, Florida
7 Duke Eye Center, Duke University Medical Center, Durham, North Carolina
8 Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
9 Wheaton Eye Clinic, Wheaton, Illinois
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
A diagnosis for primary open-angle glaucoma (POAG) suspect is established by the presence of one of the following conditions: a consistently elevated intraocular pressure (IOP), a suspicious-appearing optic nerve, or abnormal visual field.
Highlights of established risk factors for a POAG suspect diagnosis include an elevated IOP, family history of glaucoma or glaucoma suspect, thin central cornea, race, older age, myopia, and type 2 diabetes.
The decision to treat a POAG suspect patient may depend on evidence of optic nerve changes, any visual field defect, level of IOP, and other associated risk factors.
In the Ocular Hypertension Treatment Study (OHTS) overall, 90% to 95% of patients with ocular hypertension did not go on to develop glaucoma over 5 years, but treatment to reduce IOP also reduced the risk of developing POAG from 9.5% to 4.5%.4
(4Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120:701-13; discussion 829-30.)
A reasonable target for IOP reduction in a POAG suspect patient is 20%, based on the OHTS.
Appropriate testing to evaluate and monitor patients with OAG includes gonioscopy, pachymetry, tonometry, perimetry, careful observation of the optic nerve, and ocular imaging.
If a decision is made to treat IOP, options include medical eye drops or laser trabeculoplasty.