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C CLINICAL RESEARCH

Table 1: Comprehensive Glaucoma Evaluation – Recommendations for Testing

Exam Element Critical Criteria/Testing
History
Investigation of systemic risk factors
Medical history
Medications (investigate possible contraindications and cautions for
glaucoma medications)
Allergies to medications

Family history (medical and ocular)
Clinical Examination
Best corrected visual acuity (VA)
Pupillary function; check for relative afferent defect
Slit lamp examination of lids, ocular surface integrity, anterior cham-
ber, lens
Applanation tonometry (including time measured)

Blood pressure
Pachymetry
Gonioscopy
Dilated examination of: lens, ONH, RNFL, posterior pole, peripheral
retina
Ancillary Testing
Automated perimetry 24-2
Automated perimetry 10-2
Documentation of ONH/RNFL with fundus photos
Objective imaging of ONH, RNFL, and macula (most commonly
with OCT)
Follow-up
Follow-up and management recommendations clearly communicated

CASE HISTORY
A comprehensive assessment includes an investigation for concomitant medical conditions that might influence the
diagnosis of disease. This may include the identification of systemic risk factors or prior conditions that increase the
risk of POAG, or suggest a secondary or angle closure etiology. Attention should also be paid to any medical condi-
tions that might impact treatment decisions such as allergies to certain medications or contraindications to the use of
certain medications (including asthma, chronic obstructive pulmonary disease, or anterior segment inflammation).

IDENTIFICATION OF RISK FACTORS
Identification of risk factors is an important part of the diagnosis and management of POAG. Clinically, it may take
years to confirm structural damage or functional loss, so a diagnosis or management decision may be based on iden-
tifying strong risk factors for the development or progression of POAG. 56,57 Because of this, there is an increasing ap-
preciation for the importance of a thorough risk assessment as part of the comprehensive glaucoma work-up, with
the goal of recognizing individuals who are at higher risk of progressing to functional vision loss and minimizing its
subsequent impact on overall quality of life.
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