How is glaucoma diagnosed?

• A. Only IOP measurement
• B. IOP with confident diagnosis from risk factors, optic disc, OCT, and visual field testing
• C. Fundus photography alone
• D. Patient age alone

Answer: (B)

Glaucoma diagnosis comes from evidence of optic nerve damage with corresponding functional loss, not from a single test. In practice, you start with intraocular pressure as a risk factor, but high pressure alone doesn’t prove glaucoma—many people have elevated IOP without nerve damage, and some with glaucoma have normal pressure. The confident diagnosis arises from integrating multiple pieces: risk factors (age, family history, race, corneal thickness), a careful exam of the optic nerve for cupping and neuroretinal rim changes, imaging of the retinal nerve fiber layer (such as OCT), and functional testing with visual fields to document loss. Fundus photography helps document what the optic nerve looks like, but it’s not sufficient by itself to diagnose glaucoma or track progression. So combining IOP with structural and functional assessments provides the most accurate diagnosis.