If you have certain risk factors for glaucoma, but have no disease-related damage, your eye doctor may tell you that you are ‘glaucoma suspect.’ This status is sometimes called borderline glaucoma or pre-glaucoma. Here, ophthalmologist Yvonne Ou, M.D. explains what being a glaucoma suspect may mean for you, and what steps you can take to prevent the disease from developing.*

What makes a person a glaucoma ‘suspect’?

Risk factors that lead an eye doctor to suspect borderline or pre-glaucoma generally include:

• High internal eye (intraocular) pressure
• Abnormalities in your visual field
• Unusual changes in the optic nerve 

Your doctor will also consider these common risk factors for the most common form of the disease, open-angle glaucoma:

• Older age
• African or Hispanic descent
• Family history of glaucoma
• Steroid use (particularly eye drops)
• Extreme nearsightedness 

Comprehensive eye exam

Confirming whether or not you are a glaucoma suspect requires a complete eye evaluation and full health history. The eye evaluation involves examining:

• Eye pressure
• Pupil function
• Visual field testing
• Thickness of the cornea
• The front and rear of the eye
• Optic nerve structure (through imaging)
• The drainage angle between the iris and cornea

With a baseline established, follow-up visits can monitor any changes in all these measurements, along with any visible changes in the optic nerve.

Treatment options for glaucoma suspects

“If you are a glaucoma suspect, the most important ‘treatment’ is good follow-up care,” says Ou. Since most types of glaucoma progress slowly, repeat doctor visits are needed to know whether you truly have the disease and treatment should begin. 

Initial treatment options for glaucoma suspects are usually eye drops and/or laser treatment, laser for increasing fluid outflow in the drainage angle. Both options can bring down eye pressure. 

Ou says the decision to treat glaucoma suspects “is often not a cut and dry one.” Some patients, concerned about treatment side effects, prefer to wait and continue eye monitoring, while others prefer to start treatment right away.

Questions for your doctor

To help in the decision-making process, Ou suggests asking your doctor the following questions:

• “Is my eye pressure elevated?”
• “Are there abnormalities to my optic nerve or field of vision?”
• “What are my risk factors for open-angle glaucoma?”

She says that, as you and your doctor track your test results, the decision of when to begin treatment will become clearer. “The good news,” she says, “is that if glaucoma treatment is required and begins early, when there is little or no damage to the optic nerve, the risk of serious vision loss is quite small.”

*Ou, Y. (2021, July 9). What is a Glaucoma “Suspect”? BrightFocus Foundation. https://www.brightfocus.org/glaucoma/article/what-glaucoma-suspect