Diagnosis
Visual Field Evaluation
Î Eye care providers evaluate the visual field using automated static
threshold perimetry (SAP) with white-on-white stimuli. It is the gold
standard test for comparing other types of visual field testing. Careful
manual combined kinetic and static threshold testing (e.g., Goldmann
visual fields) is an acceptable alternative when patients cannot
perform automated perimetry reliably or if it is not available. If visual
field glaucomatous damage is newly detected in a glaucoma suspect
patient, it is best to repeat the testing to confirm the changes.
(II++, G, S)
Optic Nerve Head and Retinal Nerve Fiber Layer Imaging
Î The appearance of the optic nerve and, if possible, the retinal nerve
fiber layer (RNFL), should be documented for the glaucoma suspect
patient. (II++, G, S)
Although they are distinctly different methodologies, stereoscopic disc photographs and
computerized images of the nerve are complementary with regard to the information
they provide the clinician who must manage the patient.
Î In the absence of these methodologies, a nonstereoscopic photograph
or a drawing of the optic nerve head (ONH) should be recorded, but
this is a less desirable alternative to stereophotography or computer-
based imaging. (III, In, S)
Î Even though digital imaging technology is approved as an adjunct
to aid in glaucoma diagnosis, the clinician should include all
perimetric and other structural information when formulating patient
management decisions. (III, In, S)
Management
2
Î The number and severity of risk factors present, the prognosis,
management plan, and likelihood that therapy, once started, can be
long term, should be discussed with the patient and, when feasible,
with the patient's family. (G, S)
