Since glaucoma is common and a leading cause of blindness, primary care providers should screen their patients for glaucoma when risk factors are present. This can help identify patients who should be referred to an ophthalmologist for evaluation.
Criteria for screening:
(1) age >- 40 years of age
(2) one or more risk factors for glaucoma (family history, racial predisposition, etc.)
Equipment required:
(1) direct ophthalmoscope
(2) non-contact tonometry unit
(3) semi-automated visual field analyzer
Screening examinations:
(1) assessment of optic disc with the direct ophthalmoscope
(2) measurement of intraocular pressure of each eye
(3) visual field analysis, if indicated
Measure the average intraocular pressure (IOP) in each eye.
• Measure the intraocular pressure in each eye 4 times.
• Determine the average value
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Left Eye IOP
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Right Eye IOP
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Action
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<= 22 mm Hg
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<= 22 mm Hg
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discharge to next screen
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<= 22 mm Hg
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> 22 mm Hg
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perform visual field analysis (go to next table)
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> 22 mm Hg
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<= 22 mm Hg
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perform visual field analysis (go to next table)
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> 22 mm Hg
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> 22 mm Hg
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refer to specialist
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Visual Field Analysis with Increased IOP in One Eye
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Left Eye Visual Field
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Right Eye Visual Field
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Action
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normal
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normal
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repeat IOP in 1 month (go to next table)
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normal
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abnormal
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refer to specialist
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abnormal
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normal
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refer to specialist
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abnormal
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abnormal
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refer to specialist
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Repeat IOP Measurement After Normal Visual Field Analysis
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Repeat Left Eye IOP
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Repeat Right Eye IOP
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Action
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<= 22 mm Hg
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<= 22 mm Hg
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discharge to next screen
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<= 22 mm Hg
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> 22 mm Hg
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refer to specialist
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> 22 mm Hg
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<= 22 mm Hg
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refer to specialist
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> 22 mm Hg
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> 22 mm Hg
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refer to specialist
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Limitations:
• Glaucoma-related ocular damage may occur at pressures <= 22 mm Hg.
• A person presenting with signs or symptoms of an acute glaucoma attack should be referred immediately for emergency evaluation.
