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[Arguments against pressure-lowering treatment of ocular hypertension. Prophylactic treatment is unnecessary]

J Stürmer1

  • 1Augenklinik Kantonsspital, Winterthur, Schweiz. joerg.stuermer@ksw.ch

Der Ophthalmologe : Zeitschrift Der Deutschen Ophthalmologischen Gesellschaft
|October 4, 2011
PubMed

Insights

For ocular hypertension (OHT), watchful waiting is best unless intraocular pressure (IOP) is very high or glaucoma risk is significant. Early treatment is reserved for high-risk patients or those showing disease progression.

Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Clinical Decision-Making

Context:

  • Ocular hypertension (OHT) management is debated, balancing potential benefits of intraocular pressure (IOP)-lowering treatment against the principle of "first do no harm."
  • Current diagnostic criteria for OHT are questioned due to IOP measurement imprecision and IOP being a risk factor, not a definitive sign, of glaucoma.
  • Prospective trials like OHTS and EGPS provide risk stratification data for glaucoma conversion.

Purpose:

  • To critically evaluate the indications for initiating IOP-lowering treatment in patients diagnosed with ocular hypertension.
  • To define thresholds for intervention based on IOP levels, individual glaucoma conversion risk, and the presence of glaucomatous changes.
  • To emphasize the "watchful waiting" approach for low-to-intermediate risk OHT patients, prioritizing harm reduction.

Summary:

  • IOP-lowering treatment for OHT is generally not recommended unless IOP exceeds 32 mmHg, due to measurement imprecision and IOP being only a risk factor for glaucoma.
  • For IOP between 21-32 mmHg, glaucoma conversion risk must be assessed using validated risk calculators; only high-risk (>13%) individuals benefit from prophylactic treatment.
  • The potential for local and systemic side effects of IOP-lowering medications outweighs the benefits for low-to-intermediate risk OHT patients, supporting a "watchful waiting" strategy.

Impact:

  • This evidence-based approach aims to optimize patient outcomes by minimizing unnecessary treatment and associated risks in ocular hypertension management.
  • Promotes a personalized treatment strategy, reserving interventions for those most likely to progress to glaucoma, thereby improving the risk-benefit ratio.
  • Highlights the importance of ongoing monitoring for morphological or functional progression, enabling timely initiation of IOP-lowering therapy when clinically indicated.

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