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Beyond the Basics: The Glaucoma Suspect Evaluation



Most of us associate a glaucoma screening with the "air puff test". While we no longer use this method, our team gathers extensive details during your yearly eye exam to establish your personal risk profile. Since glaucoma can lead to irreversible blindness, if one or more risk factors are detected, your doctor will request a follow-up evaluation.


Routine Tests: Performed during every comprehensive eye exam

  1. High-risk history: age, ethnicity, family history, refractive history, medical conditions, ocular trauma, and certain medications

  2. Peripheral vision testing: This involves covering one eye, focusing on the doctor's eye, and counting the number of fingers shown in the periphery.

  3. Pupil testing: The doctor checks how your pupils respond to light, providing insights into nerve function.

  4. Pressure testing: We use the iCare handheld device for fast, painless pressure measurements. If elevated pressure is detected, the doctor may perform the Goldmann "blue light" test with numbing eye drops.

  5. Dilated retinal exam: Dilation allows a 3D view of the optic nerve and retina, aiding in detecting subtle changes. If considered low risk, your doctor may recommend every other year for a dilated retinal exam.

  6. Retinal photo: Detailed images assist in monitoring structural changes over time.



The Glaucoma Suspect Evaluation: What happens at follow-up?

The good news is, if you were dilated at the first visit, you most likely will not need to be dilated again at follow-up.


  1. Visual acuity testing: Even if your follow-up seems close to your annual exam, it's important that our team measures how you read the eye chart at every visit. This is essential for detecting central changes in visual function.

  2. Visual Field Testing: Glaucoma often affects peripheral vision before central vision. Unlike counting fingers, visual field testing assesses the full extent of peripheral vision. The test involves wearing an eye patch and responding to light stimuli while staring straight ahead at a fixation target. The test can take up to 5 minutes per eye.

  3. Optical Coherence Tomography (OCT): OCT is a non-invasive imaging test capturing detailed cross-sectional images of the cornea, optic nerve, and retinal layers. During an OCT, you'll sit in front of an instrument. Your chin will be placed on a rest, and you'll focus on a target. The technician will scan your eyes with harmless light waves, creating detailed images. It's quick, painless, and helps your doctor assess corneal thickness, retinal ganglion cells, and retinal nerve fiber layers.

  4. Intraocular pressure (IOP): Just like reading the eye chart, your eye pressure will be measured at every visit, regardless of how recently or how many times you have had your pressure checked before. Repeated IOP measurements, especially at different times of the day, allow your doctor to establish a healthy target pressure for your eyes. A normal IOP typically ranges between 10 and 21 mmHg. However, individual variations exist, and normal values may differ based on factors like age, ethnicity, and overall eye health. Additionally, IOP can vary throughout the day, emphasizing the importance of considering the entire clinical picture for a comprehensive assessment.

  5. Electroretinography (ERG): Similar to an EKG for the heart, ERG testing assesses the retina's electrical responses to light stimuli. This advanced technology provides sensitive, objective tracking of retinal changes for more informed follow-up, even where no changes in visual field or retinal nerve fiber layer could be detected. An adhesive sensor strip will be placed beneath each eye and testing takes less than a few minutes for both eyes.



Summary: What happens after all of this testing?

Remember, a glaucoma suspect designation is not a definitive diagnosis, but rather an opportunity for collaborative care aimed at preserving your vision for years to come. Throughout the evaluation process, we prioritize patient education and collaboration. Understanding your eye health and the significance of the tests performed is crucial. We encourage open communication, ensuring that you are actively involved in decisions regarding your eye care and any necessary interventions.


At the conclusion of the evaluation, your doctor will sit and review all gathered data with you. Glaucoma suspects typically do not require immediate treatment but necessitate vigilant monitoring for early signs of glaucomatous damage. Diagnosis often relies on the presence of three criteria: elevated intraocular pressure (IOP), optic nerve damage, and visual field loss. When some of these criteria are absent, diagnosing glaucoma becomes challenging. Hence, adherence to follow-up appointments is crucial for preserving long-term vision health.


Don't let missing your annual eye exam be the reason you develop irreversible vision loss. Click here to schedule your comprehensive eye exam today!


In good health,



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