A 59 y/o black male presented with complaints of reduced vision at near, in both eyes. His distance vision was not a problem. He said he had no history of significant eye disease, nor did his family. He did state he had slightly elevated blood pressure from time, to time, but that his doctor did not feel treatment was needed at this point. The only medication he was on was an occasional Ibuprofen for migraine headaches.

His uncorrected distance vision was 20/50 in the right eye and 20/70+ in the left. His habitual, mildly hyperopic correction gave 20/25 vision in the right eye, 20/25- in the left.

Biomicroscopy revealed a slightly shallow chamber depth and clear corneas.

IOP was 28mm Hg in the right eye, and 27 mm Hg in the left.

Fundus evaluation showed normal vasculature, and unremarkable macular and peripheral findings. The C/D ratio in the right eye was a .6 and the left eye a .7, with both disks showing some thinning.

The accompanying photo shows the right eye during gonioscopy.

What is the condition of this patient? What abnormality, if any, does the accompanying photo reveal?

What is this condition? How should it be managed?

Thanks!