You should select additional procedures to those in the routine eye examination, according to the patient’s clinical need. You should normally: 

1. assess the optic nerve head. This would include assessing the size of the disc
2. measure the IOP. See section on the use of non-contact tonometry.

If a patient refuses to consent to tonometry after you have explained the reason for this procedure, you should record the patient’s reason for refusal. You should use your professional judgement to decide how best to manage the patient.

The examination may also include an assessment of the central visual field using perimetry with threshold control. Where necessary, you should repeat visual field assessment to obtain a meaningful result.

If the patient is at risk from glaucoma, you should assess the anterior eye and angle, for example by slit lamp – Van Herick technique. You should also look for signs of pigment dispersion syndrome (PDS) and pseudoexfoliation (PEX).

Optic nerve head imaging, including photography and OCT, may be helpful for the assessment and detection of abnormal structural changes to the optic nerve head. You should stay up to date with the evidence and be cautious about management decisions based on imaging alone.

You should follow local protocols and referral filtering pathways for people presenting with ocular hypertension or evidence of glaucoma.