The correct answer is E (A and B are correct)
Chronic (primary open-angle) glaucoma is indeed asymptomatic in early stages AND presents with gradual vision loss progressing to tunnel vision, making both statements A and B correct. 1
Why Both A and B Are Correct
Statement A: Asymptomatic in Early Stages
The 2021 American Academy of Ophthalmology guidelines explicitly define mild POAG as having "definite optic disc, RNFL, or macular imaging abnormalities consistent with glaucoma...and a normal visual field" 1. This confirms that patients in early disease stages have structural damage without subjective symptoms or detectable functional loss on standard testing. The disease is characterized as a "chronic, progressive optic neuropathy" where "early diagnosis and treatment can generally prevent visual disability" 1—emphasizing that symptoms develop late, after preventable damage has occurred.
Statement B: Gradual Vision Loss with Tunnel Vision
The guidelines describe characteristic visual field progression: initially "nasal step, arcuate field defect, or paracentral depression," advancing to moderate disease with "visual field abnormalities in one hemifield," and ultimately severe disease with "visual field abnormalities in both hemifields" 1. This progressive peripheral visual field constriction leading to central tunnel vision is the hallmark functional manifestation of advancing POAG.
Why C and D Are Incorrect
Statement C: "Unilateral, rarely bilateral" - FALSE
The guidelines explicitly state POAG is "generally bilateral, but often asymmetric" 1. While the disease may progress at different rates between eyes, bilateral involvement is the rule, not the exception.
Statement D: "The optic disc is normal" - FALSE
Optic disc abnormalities are definitional for POAG. The guidelines describe multiple characteristic changes including "diffuse or focal narrowing or notching of the optic disc rim," "progressive narrowing of the neuroretinal rim with associated increase in cupping," and "optic disc hemorrhages" 1. The optic disc is fundamentally abnormal in this disease.
Clinical Pitfall
The asymptomatic nature of early POAG means patients often present only after irreversible damage has occurred. Since visual impairment from glaucoma is irreversible 2, screening high-risk populations (older age, African or Latino/Hispanic ethnicity, family history, elevated IOP, diabetes, myopia, thin cornea) 1 is essential for detecting disease before symptomatic vision loss develops.