ICO International Clinical Guidelines:
Primary Open-Angle Glaucoma Suspect (Initial and Follow-up Evaluation)
More on the Guidelines:
(You can also download this Guideline as a PDF file - 109 KB)
On this page:
- Initial exam history
- Initial physical exam
- Management plan for patients in whom therapy is
indicated
- Follow-up exam history
- Follow-up physical exam
- Recommended guidelines for Follow-up [B:III]
- Patient education for patients with medical therapy
Initial Exam History (Key elements)
- Ocular history [A:III]
- Systemic history [A:III]
- Family history [A:III]
- Review of pertinent records [A:III]
- Assessment of impact of visual function on daily living and activities [A:III]
Initial Physical Exam (Key elements)
- Visual acuity [A:III]
- Pupils [B:II]
- Slit-lamp biomicroscopy of anterior segment [A:III]
- Measurement of IOP [A:I]
- Central corneal thickness [A:II]
- Gonioscopy [A:III]
- Evaluation of optic nerve head and retinal nerve fiber layer, with magnified stereoscopic visualization [A:III]
- Documentation of the optic disc morphology, best performed by color stereophotography or computer-based image analysis [A:II]
- Evaluation of the fundus (through a dilated pupil whenever feasible) [A:III]
- Visual field evaluation, preferably by automated static threshold perimetry [A:III]
Management Plan for Patients in Whom Therapy is Indicated
- An appropriate initial goal is to set target pressure 20% less than mean of several IOP measurements and <24 mm Hg. [A:I]
- Choose regimen of maximal effectiveness and tolerance to achieve desired therapeutic response. [A:III]
Follow-up Exam History
- Interval ocular history [A:III]
- Interval systemic medical history and any change of systemic medications [B:III]
- Side effects of ocular medications if patient is being treated [A:III]
- Frequency and time of last glaucoma medications, and review of use, if patient is being treated [B:III]
Follow-up Physical Exam
- Visual acuity [A:III]
- Slit-lamp biomicroscopy [A:III]
- IOP and time of day measurement [A:III]
- Gonioscopy is indicated when there is a suspicion of an angle-closure component, anterior chamber shallowing or unexplained change in IOP [A:III]
Recommended Guidelines for Follow-up [A:III]
|
Treatment |
Target IOP Achieved |
High Risk of Damage |
Follow-up Interval |
Frequency of Optic Nerve Head and Visual Field Evaluation |
|
No |
N/A |
No |
6-24 months |
6-24 months |
|
No |
N/A |
Yes |
3-12 months |
6-18 months |
|
Yes |
Yes |
Yes |
3-12 months |
6-18 months |
|
Yes |
No |
Yes |
< 4 months |
3-12 months |
Patient Education for Patients with Medical Therapy
- Discuss number and severity of risk factors, prognosis, management plan and likelihood that therapy, once started, will be long term. [A:III]
- Educate about disease process, rationale and goals of intervention, status of their condition, and relative benefits and risks of alternative interventions. [A:III]
- Educate about eyelid closure and nasolacrimal occlusion when applying topical medications to reduce systemic absorption. [B:II]
- Encourage patients to alert their ophthalmologist to physical or emotional changes that occur when taking glaucoma medications. [A:III]
* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2006 (www.aao.org)
(You can also download this Guideline as a PDF file - 109 KB)
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