The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Ocular hypertension (OHT) is consistently high intraocular pressure (IOP) in the absence of optical nerve damage, visual field defect or any other pathology that could explain it. Population prevalence estimates range from 4.5% to 9.4% in those aged over 40. One in 10 of patients in whom the condition is left untreated develop primary open angle glaucoma (POAG) within 5 years. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating OHT. It provides recommendations for non-pharmacological management approaches and treatment options, and for when referral may be appropriate.
What is ocular hypertension?
If a person has a consistently raised eye pressure but no signs of glaucoma, he or she is said to have Ocular Hypertension (OHT). This condition does not cause symptoms and is not glaucoma, as there is no damage to the optic nerve (the nerve of sight), but untreated OHT nevertheless leads to Primary Open Angle Glaucoma (POAG) in 10% of patients within five years.
How is ocular hypertension managed?
Both the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) have produced detailed advice on the diagnosis and management of this condition. The optometrist can predict the risk of a patient with OHT developing POAG within five years with the aid of a risk calculator that is available online.
An optometrist who diagnoses a case of OHT and who believes that there is a moderate or high risk of progression to POAG may decide to refer the patient to an ophthalmologist or an optometrist with a specialist qualification in glaucoma. The case can then be re-assessed and, if necessary, treatment with pressure-lowering medications or a laser procedure called selective laser trabeculoplasty (SLT), which slows the production of fluid or increases its drainage.
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