Page 9 - 21st Century Perspective - Glaucoma Supplement

Figure 4.​ Looking at the pattern deviation probability plots, one can readily note near-total superior loss OD and early superior loss
OS. Because the patient's scotomas evolved over several years, she was asymptomatic to this loss of field.

The patient’s IOP measurements at follow-up were even lower than at her initial presentation (16

mm Hg in the right eye and 15 mm Hg in the left eye). This clearly demonstrates the relative
unimportance of IOP compared with attentive ophthalmoscopy via slit lamp-with-condensing-lens
observation. Despite efforts to have the patient return to her optometrist of many years, she chose to
stay with her new doctor. This case illustrates the importance of not only providing good
comprehensive care to patients but also ensuring your patients know you are skilled to treat a variety
of eye conditions.

Diagnostic summary

Although glaucoma diagnosis is usually straightforward, sometimes it can be challenging. If the
comprehensive evaluation is inconclusive, do not worry. Clearly, the case is not obvious glaucoma,
so simply see the patient every few months for follow-up, repeating the indicated testing as often as
is medically necessary. If diagnostic testing remains stable over the years, then it is not glaucoma,
because by definition, glaucoma is a progressive optic neuropathy. If, over time, the evaluation
yields enough data to make a firm diagnosis, then, depending on numerous factors and
considerations, continue to attentively follow the patient, or initiate treatment. There are two pivotal

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