Glaucoma suspects

[JennyW]

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I work two days a week for an opthalmology group. The two doctors there do full glaucoma workups on "glaucoma suspects." (HRT/VFE/PAC/GOINO/PHOTOS) This seems reasonable enough, however they term people with a family history a glaucoma suspect, regardless of the age that the family member developed glaucoma.

So I see a lot of 25 year olds with IOPS of 14, and C/Ds of 0.2, but who's grandmother had glaucoma.

1: What are your thoughts on this?
2: What level of importance do you assign to family history when evaluating POAG patients.
3: What is your experience with the incidence of POAG in the 10-50 year old population? The literature that I have read says it's essentially zero.

Jen

 

[Andrew_Doan]

Family history is very important, but I usually call people Glaucoma suspects based on optic nerve appearance or IOPs. If it's by family, then I write "glaucoma suspect by family history".

Although the incidence of POAG is low in young patients, it's not a bad idea to do a baseline exam and tests on patients for later comparison. If the C/D is 0.2, then I wouldn't do visual fields/HRT/photos/OCT unless there was a change, increased C/D, IOP spike, or appearance of a disc hemorrhage.

 

[JennyW]

Family history is very important, but I usually call people Glaucoma suspects based on optic nerve appearance or IOPs. If it's by family, then I write "glaucoma suspect by family history".

Although the incidence of POAG is low in young patients, it's not a bad idea to do a baseline exam and tests on patients for later comparison. If the C/D is 0.2, then I wouldn't do visual fields/HRT/photos/OCT unless there was a change, increased C/D, IOP spike, or appearance of a disc hemorrhage.

That's very reasonable, and very much in line with how I manage patients. I am a fan of photos. I take a lot of them.

But would you call a 25 year old with normal IOPS and C/Ds a "glaucoma suspect" simply because their 85 year old grandmother has it, and was diagnosed when she was 78??

Jenny

 

[mdkurt]

But would you call a 25 year old with normal IOPS and C/Ds a "glaucoma suspect" simply because their 85 year old grandmother has it, and was diagnosed when she was 78??

Jenny

No, I wouldn't. Only about 50% of glaucoma patients are currently diagnosed and being treated in this country. There are some pretty smart people from Baltimore that feel that the other 50% are the family members of the people we're treating. This is sound reasoning. When the young family member is sitting in your chair and has a clearly normal exam, however, the workup should probably stop there (for the time being).