Diagnosis
Clinical Findings Characteristic of POAG
Evidence of optic nerve damage from either, or both, of the following:
Optic disc or RNFL structural abnormalities
• Diffuse or focal narrowing, or notching, of the optic disc rim, especially at the
inferior or superior poles, which forms the basis for the ISNT rule
• Progressive narrowing of the neuroretinal rim with an associated increase in cupping
of the optic disc
• Diffuse or localized abnormalities of the parapapillary RNFL, especially at the
inferior or superior poles
• Disc rim, parapapillary RNFL, or lamina cribrosa hemorrhages
• Optic disc neural rim asymmetry of the two eyes consistent with loss of neural tissue
• Large extent of parapapillary atrophy
Reliable and reproducible visual field abnormality — considered a valid
representation of the subject's functional status
• Visual field damage consistent with RNFL damage (e.g., nasal step, arcuate field
defect, or paracentral depression in clusters of test sites)
• Visual field loss across the horizontal midline in one hemifield that exceeds loss in
the opposite hemifield (in early/moderate cases)
• Absence of other known explanations (e.g., optic disc drusen, optic nerve pit)
Adult onset
Open anterior chamber angles
Absence of other known explanations (i.e., secondary glaucoma) for progressive
glaucomatous optic nerve change (e.g., pigment dispersion, pseudoexfoliation
[exfoliation syndrome], uveitis, trauma, and corticosteroid use)
4
