Glaucoma
Glaucoma Suspect
Also known as: glaucoma suspect, OHT suspect, suspicious optic nerve, suspicious disc, pre-glaucoma, ocular hypertension suspect, elevated IOP no damage, large cup no field loss
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A patient with findings suggestive of glaucoma but without definite, repeatable and concordant structural or functional damage. Suspicious disc, RNFL, or visual field; or elevated IOP with open angles. Reproducible glaucomatous structure-function damage is no longer merely a suspect state even when measured IOP is within the statistically normal range; use the normal-tension glaucoma pathway after reviewing angle status, prior treatment, CCT, diurnal pressure context, and mimics. Routine pathway applies to low-risk or stable suspects needing diagnosis refinement and planned monitoring. Prompt referral is required when suspicion is high, findings progress, IOP rises, angles are narrow/occludable, or repeatable field/OCT defects correlate with the disc.
Recognition
Symptoms: what patients report
- Usually asymptomatic.
- No field loss reported — visual field defects are typically subclinical until moderate.
- May present for routine exam or family-history screening.
Signs: what the examination shows
- Suspicious optic disc: large cup, vertical elongation, focal rim thinning, asymmetry between eyes (>0.2 C/D difference).
- Suspicious RNFL: wedge defect, slit defect, or diffuse thinning on OCT or red-free photo.
- Suspicious visual field: equivocal defect, borderline hemifield or arcuate pattern, or poor reliability.
- Elevated IOP with open angles — above 21 mmHg; CCT must be considered.
- Gonioscopy: open angles — essential to exclude angle closure.
What OptoGuide™ covers for glaucoma suspect
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Primary Open-Angle Glaucoma Suspect PPP — AAO
- Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern®. Gedde SJ, Kolomeyer NN, Challa P, et al. Ophthalmology. 2026;133(4):P104-P152.
- Glaucoma in Adults—Screening, Diagnosis, and Management: A Review. Stein JD, Khawaja AP, Weizer JS. JAMA. 2021;325(2):164-174.
- Diagnosis and Clinical Features of Common Optic Neuropathies. Biousse V, Newman NJ. The Lancet. Neurology. 2016;15(13):1355-1367.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.