Current Concepts in the Diagnosis of Primary Open Angle Glaucoma

BACKGROUND: Primary open angle glaucoma is characterized by quantifiable parameters including the intraocular pressure, the aqueous outflow facility, and geometric measurements of the optic disc and visual defects. Despite this, diagnosis remains controversial. OBJECTIVE: To review the current concepts in the diagnosis of primary open angle glaucoma and adapt them to situations where high technology facilities are lacking. DATA SOURCE: Information was obtained from journals/ medline, Hinari, the American Academy of Ophthalmology preferred practice pattern CD, and reputable textbooks using publications from 1972 to 2007. RESULTS: The Preferred Practice Pattern Committee of the American Academy of Ophthalmology recommends that the comprehensive initial glaucoma evaluation (history and physical examination) includes comprehensive adult eye evaluation with special attention to those factors that specifically bear on the diagnosis such as the optic disc, nerve fibre layer and visual field evaluation, open anterior chamber angles on gonioscopy and absence of secondary causes of glaucoma. Intraocular pressure is no longer relied on in the diagnosis of primary open angle glaucoma. Sequential evaluation of optic disc cup and size, neuroretinal rim size and shape, retinal nerve fiber layer, presence of peripapillary atrophy, and presence of retinal or optic disc haemorrhages enhance the ability to detect glaucomatous damages. CONCLUSION: A simple systematic approach in examination of the optic discs and visual field will improve accurate diagnosis of glaucoma.