Glaucoma risk factors: When to initiate therapy

April 21, 2012

Initiating medical therapy for patients with ocular hypertension or with suspected glaucoma should include careful history taking and examination, testing, and discussion with patients, said Paul Harasymowycz, MD.

Chicago-Initiating medical therapy for patients with ocular hypertension or with suspected glaucoma should include careful history taking and examination, testing, and discussion with patients, said Paul Harasymowycz, MD.

Dr. Harasymowycz, assistant professor and chief of glaucoma service, University of Montreal, described the steps ophthalmologists can take to determine when to suggest that anti-glaucoma therapy should be started.

The history and examination help ferret out the risk factors for the development of glaucoma. These include a family history of glaucoma; the patient’s cardiovascular risk factors; central corneal thickness; IOP; pseudoexfoliation and disc hemorrhages; retinal nerve fiber layer and optic disc damage; and ocular perfusion pressure.

The results of appropriate testing for possible glaucomatous damage might point to the need to initiate anti-glaucoma therapy. These tests include optical coherence tomography with posterior pole, retinal nerve fiber layer, and optic nerve head analysis; GDx, Heidelberg Retina Tomograph; frequency-doubling technology; and standard visual field testing. Dr. Harasymowycz emphasized the importance of establishing a good test baseline to facilitate following patients over time.

Discussion with the patient is “critical” for establishing the appropriate course of action.

“Depending on the degree of risk, the patient’s comfort with that risk, with the physician’s ability to detach early change, and with the availability for further and regular follow-up, will determine if and what treatment may be appropriate,” Dr. Harasymowycz said.

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