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Whether to treat Ocular Hypertension and Glaucoma suspect or not to treat (Debatable issue)

Ocular Hypertension 

Ocular Hypertension or Glaucoma suspect 

A patient with Intraocular pressure (IOP) above the normal range (11 -21 mmHg) without any reported visual field or optic disc changes characteristic for glaucoma.
To cut it short in points, We have to consider and evaluate the following risk factors when dealing with Ocular Hypertension or glaucoma suspect 
  • Age 
  • CCT (Central corneal thickness)
  • IOP (Intraocular Pressure)
  • CDR (Cup/disc ratio)
  • PSD (Pattern standard deviation)
  • Presence of diabetes mellitus (DM) or not
According to such risk factors, we use online glaucoma risk calculator to get the presumed risk of developing glaucoma in such patients.
If GRF (Glaucoma Risk Factors) value exceeds 15% you should start treatment with the least dose and frequency required to obtain satisfactory IOP reduction)

In other words:

Who to treat Isolated Ocular Hypertension? If Intraocular pressure is more then 27 mmhg. (IOP>27mmHg)

  • Ocular Hypertension (OHT) and suspicious disc: if IOP >21 mmHg.
  • Ocular Hypertension and thin cornea: if IOP >21 mmHg.
  • Ocular Hypertension and only eye.
  • Ocular Hypertension and Central Retinal Vein Occlusion (CRVO) or Anterior ischemic optic neuropathy (AION) in either eye.
  • Ocular Hypertension and Family History of glaucoma (especially of blinding disease)
- Relatively thin corneas (CCT <555 microns) were associated with a 3-fold risk of conversion  to POAG versus thick corneas (>588 microns). 
- Some practitioners use pachymeter routinely to correct the IOP for corneal thickness.
- One  can roughly estimate  for every 20 microns that the CCT is >550 microns, the IOP is under-read by 1 mmhg
- Interestingly, this calculation reclassifies many Normal tension glaucoma (NTG) patients as high-tension Primary open angle glaucoma (POAG) and ocular hypertension patients as normals. 
 
To use glaucoma risk calculator: https://www.deverseye.org/grc/calculator.cfm

About the Author: Dr. Reda Gomah, Consultant ophthalmologist, Egypt