Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern

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 a 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. (, , )