Abstract
When to treat the patient who presents with ocular hypertension has been a question that has ‘stumped’ the ophthalmic community for decades. Population-based studies and intervention trials have provided the basis for understanding why we consider treating such patients. Although the EGPS (European Glaucoma Prevention Study) did not demonstrate that reducing intraocular pressure (IOP) with dorzolamide prevented the onset of glaucoma compared with individuals receiving a placebo, the investigators of the OHTS (Ocular Hypertension Treatment Study) found that the treatment of ocular hypertension can be delayed with topical medication when treated patients were compared with an observation group. There are differences in inclusion criteria, study design and retention rates between the EGPS and the OHTS, which may have led to the discrepancies in outcomes between these two studies. These differences provide a basis for understanding the relevance of the findings of both trials to clinical practice. The clinician should consider key risk factors such as age, thin corneal thickness measurements, large cup-to-disc ratio and mean IOP when determining who should be treated. However, the ultimate decision of when to treat will be determined by other issues such as life expectancy, the general health of the patient and the number of risk factors. Clearly, the treatment of only high-risk patients with ocular hypertension should be considered.
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Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 2002; 120: 701–13
Becker B, Morton WR. Topical epinephrine in glaucoma suspects. Am J Ophthalmol 1966; 62: 272–7
Shin DH, Kolker AE, Kass MA, et al. Long-term epinephrine therapy of ocular hypertension. Arch Ophthalmol 1976; 94: 2059–60
Kitazawa Y. Prophylactic therapy of ocular hypertension: a prospective study. Trans Ophthalmol Soc N Z 1981; 33: 30–2
Epstein DL, Krug JH, Hertzmark E, et al. A long-term clinical trial of timolol therapy versus no treatment in the management of glaucoma suspects. Ophthalmology 1989; 96: 1460–7
Kass MA, Gordon MO, Hoff MR, et al. Topical timolol administration reduces the incidence of glaucomatous damage in ocular hypertensive individuals: a randomized, double-masked long-term clinical trial. Arch Ophthalmol 1989; 107: 1590–8
Graham PA. The definition of pre-glaucoma: a prospective study. Trans Ophthalmol Soc U K 1969; 88: 153–65
Norskov K. Routine tonometry in ophthalmic practice, II: fiveyear follow-up. Acta Ophthalmol (Copenh) 1970; 48: 873–95
Levene RZ. Uniocular miotic therapy. Trans Am Acad Ophthalmol Otolaryngol 1975; 79: 376–80
David R, Livingston DG, Luntz MH. Ocular hypertension: a long-term follow-up of treated and untreated patients. Br J Ophthalmol 1977; 61: 668–74
Chisholm IA, Stead S, Tan L, et al. Prognostic indicators in ocular hypertension. Can J Ophthalmol 1991; 98: 301–7
Schulzer M, Drance SM, Douglas GR. A comparison of treated and untreated glaucoma suspects. Ophthalmology 1991; 98: 301–7
Miglior S, Zeyen T, Pfeiffer N, for the European Glaucoma Prevention Study Group. Results of the European glaucoma prevention study. Ophthalmology 2005; 112(3): 366–75
Rochtchina E, Mitchell P. Projected number of Australians with glaucoma in 2000 and 2030. Clin Exp Ophthalmol 2000; 28: 146–8
Varma R, Ying-Lai M, Francis B, et al. Prevalence of openangle glaucoma and ocular hypertension in latinos. Ophthalmology 2004; 111: 1439–48
Klein BE, Klein R, Linton KL. Intraocular pressure in an American community: the Beaver Dam Eye Study. Invest Ophthalmol Vis Sci 1992; 33: 2224–8
Klugman S. Glaucoma is second leading cause of blindness globally. Bull World Health Organ 2004; 82(11): 887–8
The Eye Diseases Prevalence Research Group. Prevalence of open-angle glaucoma among adults in the United States. Arch Ophthalmol 2004; 122: 532–8
Weinreb RN, Friedman DS, Fechtner RD, et al. Rick assessment in the management of patients with ocular hypertension. Am J Ophthalmol 2004; 138: 458–67
Pilz-Seymour J, Gross R, and the Ocular Hypertension Treatment Study (OHTS) Group. Contralateral effect on topical Badrenergic antagonists in initial one-eyed trials in the Ocular Hypertension Treatment Study. Am J Ophthalmol 2000; 130: 441–8
Hattenhauer MG, Johnson DH, Ing HH, et al. The probability of blindness from open-angle glaucoma. Ophthalmology 1998; 105: 2099–104
Oliver JE, Hattenhauer MG, Herman D, et al. Blindness and glaucoma: a comparison of patients progressing to blindness from glaucoma with patients maintaining vision. Am J Ophthalmol 2002; 133: 764–72
Wilson MR, Kosoko O, Cowan CL, et al. Progression of visual field loss in untreated glaucoma patients and glaucoma suspects in St. Lucia, West Indies. Am J Ophthalmol 2002; 134: 399–405
AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 12._Baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma. Am J Ophthalmol 2002; 134: 499–512
Lichter PR, Musch DC, Gillespie BW, et al., and the CIGTS Study Group. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology 2001; 108: 1943–53
Heijl A, Leske MC, Bengtsson B, et al., for the Early Manifest Glaucoma Trial Group. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Opthalmol 2002; 120: 1268–79
Coleman AL, Singh K, Wilson R, et al. Applying an evidencedbased approach to the management of patients with ocular hypertension: evaluating and synthesizing published evidence. Am J Ophthalmol 2004; 138 (3 Suppl.): S3–10
Kumar TR, Chandrasekhar G, Parikh R. Applying the recent clinical trials on primary open angle glaucoma: the developing world perspective. J Glaucoma 2005; 14: 324–7
Friedman DS, Wilson MR, Liebmann JM, et al. An evidencebased assessment of risk factors for the progression of ocular hypertension and glaucoma. Am J Ophthalmol 2004; 138 (3 Suppl.): S19–31
Higginbotham EJ, Gordon MO, Beiser JA, et al. The Ocular Hypertension Treatment Study: topical medication delays or prevents POAG in African Americans. Arch Ophthalmol 2004; 122: 813–20
Gordon MO, Beiser JA, Brandt JD, et al. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open angle glaucoma. Arch Ophthalmol 2002; 120: 714–20
Kass MA, The Ocular Hypertension Study Group, The European Glaucoma Prevention Study. The OHTS/EGPS prediction model for POAG. ARVO Annual Meeting; 2006 Apr 30–May 4; Fort Lauderdale (FL): 162
Asrani S, Zeimer R, Wilensky J, et al. Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma 2000; 9: 134–42
Nouri-Mahdavi K, Hoffman D, Coleman AL, et al. Advanced Glaucoma Intervention Study: predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study. Ophthalmology 2004 Sep; 111(9): 1627–35
Bengtsson B, Heijl A. A long-term prospective study of risk factors for glaucomatous visual field loss in patients with ocular hypertension. J Glaucoma 2005; 14: 135–8
Acknowledgements
Supported in part by an unrestricted grant from the Research to Prevent Blindness, New York, NY and the Ocular Hypertension Treatment Study, National Institutes of Health.
Dr Higginbotham is one of the Vice Chairs of the OHTS and has received research grants in the past from Alcon, Allergan and Pfizer.
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Higginbotham, E.J. Treating Ocular Hypertension to Reduce Glaucoma Risk. Drugs 66, 1033–1039 (2006). https://doi.org/10.2165/00003495-200666080-00001
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DOI: https://doi.org/10.2165/00003495-200666080-00001