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Glaucoma, Suspect, Adult Treatment & Management

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Sep 02, 2014
 

Medical Care

Progression to glaucoma

Start treatment if documentation of progression to glaucoma with optic nerve damage and/or reproducible visual field defect exists. The initiation of ocular hypotensive medication among glaucoma suspects significantly reduced the velocity of VF progression.[35]

Ocular hypertension

Ocular hypertension with pressure-lowering medication may delay or prevent subsequent development of glaucomatous damage. The OHTS, a large multicenter clinical trial sponsored by the National Eye Institute, studied this possibility. The OHTS concluded that for individuals with ocular hypertension at significant risk for developing glaucoma, topical ocular hypotensive medications were effective in delaying or preventing the onset of primary open-angle glaucoma (POAG).[19, 36, 37]

In general, most ophthalmologists treat patients with IOP of greater than 30 mm Hg.

Glaucoma suspects at high risk

Carefully weigh the likelihood that the patient's risk factors will contribute to glaucomatous optic nerve damage against the ocular and systemic risks that are associated with possible treatments.[38]

The decision to treat a patient who is glaucoma suspect and at high risk is individualized, considering the following: the risks and the rate at which glaucomatous damage and decreased visual function can occur, the patient's desires, expected longevity, and tolerance of treatment.

Other factors, such as reliability of visual field testing, availability of follow-up visits, and ability to examine the optic disc, may contribute to starting treatment.

If an ophthalmologist decides to treat a patient who is glaucoma suspect and at high risk, using one or more topical antiglaucoma agents to lower the IOP may be preferable.[39] The adverse effects, the profile, and the frequency of use should be weighed against the patient's ocular and medical histories. Animal data are available that suggest that Alphagan, Xalatan, or Betoptic may play a role in improving optic nerve perfusion.

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Surgical Care

In patients with very shallow, occludable anterior chamber angle depth, laser peripheral iridotomy can be a preventive measure in decreasing the risk of acute angle-closure glaucoma.

Laser trabeculoplasty is infrequently indicated for treating patients who are glaucoma suspect. In patients with POAG and OHT, the percentage of IOP reduction after SLT was significantly greater in eyes with thinner corneas (CCT < 555 μm), indicating patients with thinner corneas had better IOP control after SLT.[40]

Filtering procedures are generally reserved for patients with documented glaucomatous optic nerve damage.

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Contributor Information and Disclosures
Author

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor, U Fusun Cardakli, MD, to the development and writing of this article.

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