Page 10 - 21st Century Perspective - Glaucoma Supplement
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challenges in caring for patients: making a timely and accurate diagnosis; and determining whether
and when to initiate therapy.
Both aspects of patient care require good training, clinical seasoning and deep thought. Remember,
if there is a struggle with such decision-making, do not hesitate to get a second opinion from an
optometric colleague, and understand that any other doctor will be challenged as well.
In summary, optometrists should perform at least the following diagnostic steps:
● Screen for family history of glaucoma, especially among siblings.
● Study the optic nerve head, especially the inferotemporal and superotemporal rim tissues.
● Obtain IOP and pachymetry measurements.
● Obtain a nerve fiber layer analysis if there is any doubt. If the nerve fiber layer analysis is
questionable or pathological, then obtain a 24-2
● ·visual field.
● Perform gonioscopy (Figures 5, 6) if there is questionable angle patency.
By performing these diagnostic maneuvers, it would be virtually impossible to miss glaucoma.
Figure 5. Performing four-mirror gonioscopy.
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