eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma, Suspect, Adult: Treatment & Medication

Author: Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Contributor Information and Disclosures

Updated: Mar 19, 2009

Treatment

Medical Care

  • Indications
    • Progression to glaucoma: Start treatment if documentation of progression to glaucoma with optic nerve damage and/or reproducible visual field defect exists.
    • 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).17,28,29
      • 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.30
      • 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.31
    • 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.

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

More on Glaucoma, Suspect, Adult

Overview: Glaucoma, Suspect, Adult
Differential Diagnoses & Workup: Glaucoma, Suspect, Adult
Treatment & Medication: Glaucoma, Suspect, Adult
Follow-up: Glaucoma, Suspect, Adult
References
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References

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  2. Quality of Care Committee, Glaucoma Panel. The Glaucoma Suspect (Preferred Practice Pattern). Amer Acad of Ophthamol Bul. 1995.

  3. Quality of Care Committee, Glaucoma Panel. Primary Open-Angle Glaucoma (Preferred Practice Pattern). Amer Acad of Ophthalmol Bul. 1992.

  4. Quigley HA, Addicks EM, Green WR. Optic nerve damage in human glaucoma. III. Quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic neuropathy, papilledema, and toxic neuropathy. Arch Ophthalmol. Jan 1982;100(1):135-46. [Medline].

  5. Rader J, Feuer WJ, Anderson DR. Peripapillary vasoconstriction in the glaucomas and the anterior ischemic optic neuropathies. Am J Ophthalmol. Jan 15 1994;117(1):72-80. [Medline].

  6. Armaly MF, Krueger DE, Maunder L, et al. Biostatistical analysis of the collaborative glaucoma study. I. Summary report of the risk factors for glaucomatous visual-field defects. Arch Ophthalmol. Dec 1980;98(12):2163-71. [Medline].

  7. Kass MA, Kolker AE, Becker B. Prognostic factors in glaucomatous visual field loss. Arch Ophthalmol. Aug 1976;94(8):1274-6. [Medline].

  8. Gordon MO, Beiser JA, Brandt JD, et al. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol. Jun 2002;120(6):714-20; discussion 829-30. [Medline].

  9. Skalicky SE, Borovik AM, Masselos K, et al. Prevalence of open-angle glaucoma, glaucoma suspect, and ocular hypertension in thyroid-related immune orbitopathy. J Glaucoma. Apr-May 2008;17(3):249; author reply 249-50. [Medline].

  10. Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. JAMA. Jul 17 1991;266(3):369-74. [Medline].

  11. Leske MC, Connell AM, Wu SY, Hyman LG, Schachat AP. Risk factors for open-angle glaucoma. The Barbados Eye Study. Arch Ophthalmol. Jul 1995;113(7):918-24. [Medline].

  12. Quigley HA, Enger C, Katz J, Sommer A, Scott R, Gilbert D. Risk factors for the development of glaucomatous visual field loss in ocular hypertension. Arch Ophthalmol. May 1994;112(5):644-9. [Medline].

  13. Sheffield VC, Stone EM, Alward WL, et al. Genetic linkage of familial open angle glaucoma to chromosome 1q21-q31. Nat Genet. May 1993;4(1):47-50. [Medline].

  14. Wirtz MK, Samples JR, Kramer PL, et al. Mapping a gene for adult-onset primary open-angle glaucoma to chromosome 3q. Am J Hum Genet. Feb 1997;60(2):296-304. [Medline].

  15. Stone EM, Fingert JH, Alward WL, et al. Identification of a gene that causes primary open angle glaucoma. Science. Jan 31 1997;275(5300):668-70. [Medline].

  16. Andersen JS, Pralea AM, DelBono EA, et al. A gene responsible for the pigment dispersion syndrome maps to chromosome 7q35-q36. Arch Ophthalmol. Mar 1997;115(3):384-8. [Medline].

  17. Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. Jun 2002;120(6):701-13; discussion 829-30. [Medline].

  18. Quigley HA, Addicks EM. Chronic experimental glaucoma in primates. II. Effect of extended intraocular pressure elevation on optic nerve head and axonal transport. Investigative Ophthalmology and Visual Science. 1980;19:137-152.

  19. Sommer A, Tielsch JM, Katz J, et al. Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey. Arch Ophthalmol. Aug 1991;109(8):1090-5. [Medline].

  20. Lichter PR. Variability of expert observers in evaluating the optic disc. Trans Am Ophthalmol Soc. 1976;74:532-72. [Medline].

  21. Spencer AF, Vernon SA. Comparison of a simple ophthalmoscopic and planimetric measurement of glaucomatous neuroretinal rim areas. J Glaucoma. Jun 1996;5(3):221-2. [Medline].

  22. Jonas JB, Fernandez MC, Naumann GO. Glaucomatous optic nerve atrophy in small discs with low cup-to-disc ratios. Ophthalmology. Sep 1990;97(9):1211-5. [Medline].

  23. Zeyen TG, Caprioli J. Progression of disc and field damage in early glaucoma. Arch Ophthalmol. Jan 1993;111(1):62-5. [Medline].

  24. Jansonius NM, Heeg GP. The Groningen Longitudinal Glaucoma Study. II. A prospective comparison of frequency doubling perimetry, the GDx nerve fibre analyser and standard automated perimetry in glaucoma suspect patients. Acta Ophthalmol. Jul 18 2008;[Medline].

  25. Johnson CA, Adams AJ, Casson EJ, Brandt JD. Blue-on-yellow perimetry can predict the development of glaucomatous visual field loss. Arch Ophthalmol. May 1993;111(5):645-50. [Medline].

  26. Johnson CA, Adams AJ, Casson EJ, Brandt JD. Progression of early glaucomatous visual field loss as detected by blue-on-yellow and standard white-on-white automated perimetry. Arch Ophthalmol. May 1993;111(5):651-6. [Medline].

  27. Jansonius NM, Heeg GP. The Groningen Longitudinal Glaucoma Study. II. A prospective comparison of frequency doubling perimetry, the GDx nerve fibre analyser and standard automated perimetry in glaucoma suspect patients. Acta Ophthalmol. Jul 18 2008;[Medline].

  28. Higginbotham EJ. Ocular Hypertension Treatment Study. Arch Ophthalmol. Feb 2009;127(2):213-5. [Medline].

  29. Rhee DJ. Preventing glaucoma in a high-risk population: impact and observations of the Ocular Hypertension Treatment Study. Arch Ophthalmol. Feb 2009;127(2):216-8. [Medline].

  30. Doshi A, Singh K. Cost-effective evaluation of the glaucoma suspect. Curr Opin Ophthalmol. Mar 2007;18(2):97-103. [Medline].

  31. Blini M, Rossi GC, Trabucchi G, et al. Ocular hypotensive efficacy and safety of travoprost 0.004% in inadequately controlled primary open-angle glaucoma or ocular hypertension: short-term, multicenter, prospective study. Curr Med Res Opin. Jan 2009;25(1):57-63. [Medline].

  32. National Advisory Eye Counsel Vision Research. A National Plan. NIH. 1982;1:12-13.

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Further Reading

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Keywords

glaucoma suspect, glaucoma, IOP, intraocular pressure, high pressure inside the eye, elevated intraocular pressure, elevated IOP, POAG, primary open-angle glaucoma, ocular hypertension, OHT, ocular hypertensives, optic nerve head, optic nerve damage, visual field defect, vision loss, blindness, glaucoma risk, glaucomatous optic nerve

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Contributor Information and Disclosures

Author

Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society
Disclosure: WebMD/eMedicine Salary Employment

Medical Editor

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 and American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Martin B Wax, MD, Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc
Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience
Disclosure: Alcon Labs Salary Employment

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
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, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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