How is a glaucoma suspect defined?

• A. Suspect with normal IOP and no definitive glaucoma damage
• B. Elevated IOP with confirmed glaucoma damage
• C. Normal IOP with damage
• D. Any patient with IOP over 30

Answer: (A)

A glaucoma suspect is someone who is at risk for glaucoma based on signs or risk factors but does not yet show definite glaucomatous damage. In glaucoma, the defining features are structural damage to the optic nerve and corresponding functional loss on visual fields. If those damage markers aren’t reproducible and there isn’t established damage, but there are hints—such as a suspicious optic nerve head appearance (cupping, thinning of the neuroretinal rim), RNFL defects on imaging, or strong risk factors like family history or thin corneas—the person is labeled a suspect. In many suspects, intraocular pressure may be normal, which is common in early or normal-tension scenarios, but the key point is the absence of verifiable optic neuropathy or field loss. Those without any signs of damage, even if risk factors exist, remain suspects and are watched closely for any progression. If definite glaucomatous damage is present, the eye is no longer just a suspect, but has established glaucoma.