From the Guidelines
Open angle with borderline findings of bilateral eyes is a condition that requires monitoring, as it may indicate early glaucoma or risk for developing glaucoma, and regular eye examinations every 6-12 months are recommended to track any changes in intraocular pressure, visual field tests, and optic nerve appearance. This condition is characterized by an open anterior chamber angle and some concerning characteristics, such as optic disc or retinal nerve fiber layer (RNFL) structural abnormalities, that may indicate early glaucoma or risk for developing glaucoma 1. The decision to treat a patient with open angle and borderline findings depends on the level of intraocular pressure (IOP) and other associated risk factors, or evidence of change of the optic nerve, RNFL, or visual field indicating the development of glaucoma 1.
Some key points to consider in managing this condition include:
- Established risk factors for primary open-angle glaucoma (POAG) include older age, African race or Latino/Hispanic ethnicity, elevated IOP, family history of glaucoma, low ocular perfusion pressure, type 2 diabetes mellitus, myopia, and a thin central cornea 1.
- A reasonable target for IOP reduction in a POAG suspect patient in whom the decision to treat has been made is 20%, based on the Ocular Hypertension Treatment Study (OHTS) 1.
- Appropriate testing to evaluate and monitor patients diagnosed as a glaucoma suspect includes gonioscopy, pachymetry, tonometry, perimetry, careful examination of the optic nerve, and ocular imaging 1.
- Lifestyle modifications that may help include regular exercise, avoiding steroid eye drops unless prescribed, maintaining healthy blood pressure, and staying well-hydrated.
The goal of monitoring and possible early intervention is to prevent damage to the optic nerve and preserve vision, as any vision loss from glaucoma is irreversible. While medication is not always necessary at this stage, your ophthalmologist might prescribe eye drops such as prostaglandin analogs (like latanoprost 0.005% once daily at bedtime) if there are additional risk factors or slight pressure elevations 1.
From the Research
Definition of Open Angle with Borderline Findings
- Open angle with borderline findings refers to a condition where the intraocular pressure (IOP) is higher than normal, but not high enough to be classified as glaucoma 2.
- Borderline findings may include elevated IOP, suspicious optic disc appearance, or abnormal visual field tests, but do not meet the full criteria for a diagnosis of open-angle glaucoma 3.
Characteristics of Open Angle with Borderline Findings
- Patients with open angle and borderline findings may have a higher risk of developing open-angle glaucoma, especially if they have other risk factors such as family history, age, or certain medical conditions 4.
- Visual field testing is an important tool for monitoring patients with open angle and borderline findings, as it can help detect early signs of glaucoma progression 5.
- Intraocular pressure (IOP) control is crucial in managing open angle with borderline findings, as elevated IOP can lead to glaucoma progression 6.
Visual Field Testing and Intraocular Pressure
- Visual field testing can affect intraocular pressure (IOP) in both healthy individuals and glaucoma patients, with healthy individuals experiencing a decrease in IOP after testing and glaucoma patients experiencing an increase in IOP immediately after testing 5.
- The frequency of visual field testing is important for monitoring glaucoma progression, with guidelines recommending at least annual testing for patients with open-angle glaucoma 4.
Management and Monitoring
- Patients with open angle and borderline findings should be monitored regularly with visual field tests and IOP measurements to detect early signs of glaucoma progression 2, 3.
- Management of open angle with borderline findings may involve lifestyle modifications, such as exercise and diet, as well as medical treatment to lower IOP if necessary 6.