Economic aspects of the management of ocular hypertension

Ocular hypertension is a statistical concept, but its presence should arouse suspicion of glaucoma. Glaucoma is an optic neuropathy. Screening for ocular hypertension may not be economically sound because of the high false positive detection rate. Glaucoma is without cost until it is treated or too late. If treatment prevents visual loss it is worthwhile. However, treatment may not prevent glaucoma-induced visual loss. It could be argued that it is more economical to ignore glaucoma than to either screen for ocular hypertension or treat glaucoma. Ophthalmologists will continue to disregard these points, partly because they don't believe them or are fearful of liability, but more likely because they are more concerned about an individual person than about statistical proof of benefit and their primary goal is to avoid risk to the patient even if this is not clearly cost-effective. That decision is correct until better techniques are developed for predicting visual field loss and more effective therapies are established to prevent visual field loss.