Open-angle: Diagnostics

• Initially often asymptomatic

• Over time, nonspecific symptoms such as mild headaches, impaired adaptation to darkness

• Generally bilateral, progressive visual field loss (from peripheral to central)

• Arcuate scotoma: arch-shaped scotoma that starts from the blind spot

• Slit-lamp examination of the anterior segment: normal appearing anterior chamber angle

• Tonometry

  • To measure IOP (standard values range between 10–21 mm Hg)

  • Elevated IOP may be seen in up to 40% of patients with primary open-angle glaucoma but is not a requirement for diagnosis [5]

• Gonioscopy: to rule out angle-closure glaucoma

• Fundoscopy: cupping and pallor of optic disc, disc hemorrhage, diffuse or focal narrowing of the optic disc rim

• Perimetry: visual field testing to detect blind spots in the visual field

Glaucomatous excavation of the optic disc

Fundus photography of a right eye

An enlarged cup (yellow overlay) of the optic disc with thinning of the neuroretinal rim (green overlay) can be seen, especially evident in the temporal superior area of the optic disc (focal notching, indicated by arrow). Cupping leads to kinking of the blood vessels at the base of the cup (examples indicated by arrowheads).

This is a pathognomonic finding in glaucoma, predominantly caused by elevated intraocular pressure.