Open-angle glaucoma

Last reviewed: 28 Feb 2023
Last updated: 03 Oct 2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cup-to-disc ratio >0.4
  • notching of optic nerve cup
  • peripheral vision loss
  • increased intra-ocular pressure
  • scotomas
  • loss of nerve fibre layer
  • retinal haemorrhage
More key diagnostic factors

Risk factors

  • intra-ocular pressure >23 mmHg
  • age >50 years
  • family history of glaucoma
  • black ethnicity
  • myopia
  • diabetes mellitus
  • hypertension
More risk factors

Diagnostic investigations

1st investigations to order

  • tonometry
  • direct ophthalmoscopy
  • indirect ophthalmoscopy
  • slit-lamp biomicroscopy
  • visual field testing
More 1st investigations to order

Investigations to consider

  • gonioscopy
  • photographs of the optic nerve head
  • pachymetry
  • nerve fibre layer analysis
  • optical coherence tomography scanning
More investigations to consider

Treatment algorithm

ACUTE

elevated intra-ocular pressure and/or visual and retinal changes

Contributors

Authors

Nishani Amerasinghe, MBBS, BSc(Hons), FRCOphth

Consultant Ophthalmic Surgeon

Glaucoma Specialist

University Hospital Southampton NHS Trust

Southampton

UK

Disclosures

NA has received travel honoraria and speaker's fees from Thea Pharmaceuticals and Allergan. She is also a principal investigator on an Aerie Pharmaceuticals study.

Acknowledgements

Dr Nishani Amerasinghe would like to gratefully acknowledge Dr Robert B. Avery and Dr Michael N. Wiggins, the previous contributors to this monograph. RBA and MNW declare that they have no competing interests.

Peer reviewers

Richard A. Harper, MD

Associate Professor of Ophthalmology

Department of Ophthalmology

Jones Eye Institute

University of Arkansas for Medical Sciences

Little Rock

AR

Disclosures

RAH declares that he has no competing interests.

Roshini Sanders, FRCS, FRCOphth

Consultant Ophthalmologist

Queen Margaret Hospital

Dunfermline

Fife

UK

Disclosures

RS declares that she has no competing interests.

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