This document summarizes information about ocular hypertension (OHT) and glaucoma risk factors. It finds that 9.5% of patients with OHT developed glaucoma within 5 years without treatment, compared to 4.4% of treated patients. Thin corneas, elevated intraocular pressure, increasing age, optic nerve cupping, and visual field defects increase glaucoma risk. For OHT patients, a 20% IOP reduction can delay or prevent glaucoma, but most low-risk OHT patients can be monitored without medication, while high-risk patients may benefit from more frequent exams and early treatment based on their age, health, life expectancy, and preferences.

1. Dr. Samarth Mishra

2.  IOP > 21 mm Hg
 No visual field defect
 Normal appearance of the optic disc and
nerve fiber layer
 Open angles on gonioscopy
 No ocular or systemic cause of increased
IOP

3.  4-10% of the population > 40 year.
 black > White
 More in Women (Barbados Eye Study)

4. Ocular Hypertension Treatment Study
At the end of 5 years, 9.5% of the
observation group developed a glaucoma
‘end point’ whereas only 4.4% of the
treated group.

5. • Unknown
• IOP initiates glaucomatous damage include
(1) onset of vascular dysfunction causing ischemia to the
optic nerve
(2) mechanical dysfunction via cribriform plate
compression of the neuronal axons.

6. Prospectively proven risk factors
1.Thin corneas (<535 microns)
2.Elevated intraocular pressures
3.Increasing age
4.Vertical cupping of the optic nerve (>0.6)
5.Increased pattern standard deviation on threshold
perimetry
6.Abnormalities in the optic nerve with the scanning laser
ophthalmoscope
7.Pseudoexfoliation

7. Mean IOP CCT <555 CCT >555 to
<588
CCT >558
>25.75 mm hg 36% 13% 6%
>23.75 to < 25.75
mm hg
12% 10% 7%
<23.75 mm hg 17% 9% 2%
C:D CCT <555 CCT >555 to
<588
CCT >558
>0.5 22% 16% 8%
>0.3 to <5.0 26% 16% 4%
<0.3 15% 1% 4%

10.  Past ocular history –
1. pain or redness
2. multicolored halos
3. headache
4. previous ocular disease, including cataracts, uveitis, diabetic
retinopathy, and vascular occlusions
5. previous ocular surgery, including photocoagulation or refractive
procedures
6. ocular/head trauma
 Past medical history – Cardiovascular disease, diabetes mellitus,
migraine headache, hypertension, and vasospasm

12. 1. Intraocular Pressure and Pachymetry
2. Slitlamp Biomicroscopy and Gonioscopy
3. Fundus Examination
4. Visual Fields
5. Imaging of the Optic Nerve and Nerve Fiber Layer
6. Ocular Blood Flow

13. • 20% reduction in IOP: delay or prevent the onset of
glaucoma.
• Most OHT patients are at low risk. Most low risk OHT
patients can be followed without medication.
• High risk OHT patients may benefit from more frequent
examinations and early treatment taking into
consideration:
1. Patient age
2. Health status
3. Life expectancy
4. Personal preference

14. Thank you