Figure 1. Management Algorithm for Patients with
Primary Open-Angle Glaucoma Suspect
NO
Patient with POAG
Suspect Diagnosis
a
Discuss treatment
benefits and risks
with patient
Follow-up every
12 to 24 months
YES
Patient high
risk?
b
NO
Follow-up in
≤12 months
Estimate initial
target pressure and
initiate treatment
YES
Decision to
treat
YES
Target
pressure
achieved?
NO
Ensure adherence
with therapy,
reassess target
pressure, and
consider adjusting
treatment
regimen
Follow-up as often as
necessary to adjust
therapy until target
pressure achieved
a
e clinical findings that
define a glaucoma suspect are
characterized by one of the
following in at least one eye
in an individual with open
anterior-chamber angles by gonioscopy:
• Appearance of the optic disc or retinal
nerve fiber layer that is suspicious for
glaucomatous damage.
• A visual field suspicious for
glaucomatous damage.
• Consistently elevated IOP associated
with appearance of the optic disc and
retinal nerve fiber layer and with normal
visual field test results.
b
e overall likelihood of developing
glaucomatous optic neuropathy increases
with the number and relative strength of
risk factors, which include the following :
• Elevated IOP
• Older age
• Family history of glaucoma
• Increased cup-to-disc ratio
• inner central corneal thickness
• Disc hemorrhage
• Larger mean pattern standard deviation on
threshold visual field testing
• Lower ocular perfusion pressure
• Lower systolic and diastolic blood pressure
• Pigment dispersion syndrome
• Pseudoexfoliation
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