Management
Breast-feeding
Î Brimonidine is known to cross the blood-brain barrier and can cause
apnea in infants. For this reason, it is usually recommended that
brimonidine NOT be used in mothers who are breast-feeding. (III, G, S)
Follow-up Evaluation
Î Primary open-angle glaucoma suspect patients who are being
observed should be seen at least every 12 to 24 months, depending on
individual risk factors. (G, S)
Adjustment of Therapy
Î In glaucoma suspect patients, decisions for therapeutic intervention
should aim to minimize risks from treatment, whereas in POAG, the
decision to treat aims to minimize the risks of glaucoma disease
progression. (G, S)
4
The indications for adjusting therapy in glaucoma suspect
patients are as follows:
• Target IOP is not achieved and the benefits of a change in therapy outweigh the risks
for the patient
• The patient is intolerant of the prescribed medical regimen
• The patient does not adhere to the prescribed medical regimen
• Contraindications to individual medicines develop
• The patient under treatment has been stable for a prolonged period without
progression to POAG. In this case, cautious withdrawal of therapy may be considered.
Counseling And Referral
Î Patients should be educated about their condition and its potential
to lead to the blinding disease glaucoma, the rationale and goals of
intervention, the status of their condition, and the relative benefits
and risks of alternative interventions so that they can participate
meaningfully in developing an appropriate plan of action. (G, S)
Î Patients should be encouraged to alert their ophthalmologist to
physical or emotional changes that occur when taking glaucoma
medications, if prescribed. (G, S)
Î Patients considering keratorefractive surgery should be informed about
the possible impact laser vision correction has on reducing contrast
sensitivity and decreasing the accuracy of lOP measurements. (G, S)
