What factors should be weighed before treating a high-risk glaucoma suspect?

Updated: Jul 27, 2020
  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

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. [40] Lim et al found that 2.6% of normal-tension glaucoma suspects progressed to glaucoma per year, with higher baseline IOP and thin average retinal nerve fiber layer being risk factors for progression. [41]

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. [42] The adverse effects, the profile, and the frequency of use should be weighed against the patient's ocular and medical histories.


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