Who should seek medical attention for ocular hypertension?

Who should seek medical attention for ocular hypertension?
Eyes Ocular hypertension affects who?  
  Who should seek medical attention for ocular hypertension?

Glaucoma is the most prevalent cause of blindness that cannot be reversed, and it is also known as the “silent thief of sight.” The optic nerve is harmed when intraocular pressure is too high. This results in a loss of peripheral vision (what you see out of the side of your eyes) and eventually an impairment of central vision (what you see when looking straight ahead). In most cases, patients are unaware of any symptoms until they begin to experience vision loss.


Eyes Ocular hypertension affects who?


The only treatment that is known to prevent or interrupt the progression of glaucoma is a reduction in excessive eye pressure. But does everyone who has eye pressure that is higher than usual need to get treatment for it? An extensive research project that was conducted over a lengthy period of time has yielded some results, but they are not yet definitive.

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Does glaucoma always develop in patients who have high eye pressure?

Glaucoma is believed to afflict three million people in the United States, yet only half of those affected are aware that they have the condition. A thorough eye exam can be performed by an ophthalmologist to establish whether or not a person has glaucoma, or whether or not they are at risk for getting glaucoma in the future due to excessive eye pressure (ocular hypertension). Some people with high eye pressure may never develop glaucoma, while others will almost certainly do so at some point in their lives. These findings come from the long-running Ocular Hypertension Treatment Study (OHTS).


Who should seek medical attention for ocular hypertension?


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The OHTS was initiated in 1994 as a multicenter, randomized clinical study, and it continues to contribute to our understanding of individuals who have high ocular pressure, their risk of getting glaucoma, and whether or not they can take drugs to prevent glaucoma.




The researchers recruited a wide variety of 1,636 patients suffering from ocular hypertension from 22 different locations across the United States. In order to conduct a study on the prevention of glaucoma, participants were randomly allocated to either begin early treatment with eye drops that lower eye pressure (the medication group) or close observation (control group).




The data gathered after five years revealed that only 4.4% of individuals in the pharmaceutical group got glaucoma, in contrast to 9.5% of those in the control group. This tells us that beginning treatment with medicated eye drops at an earlier age helps delay the onset of glaucoma in over fifty percent of instances among persons who have ocular hypertension.


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In subsequent stages of the research, participants in the control group were given the opportunity to take ocular pressure-lowering medication. This was done to determine whether or not commencing medication later may still delay the onset of glaucoma, which it did. Glaucoma developed in approximately 49% of the people in the control group and in approximately 42% of the people in the treatment group after 20 years. The researchers were unable to assess the 20-year risk decrease between the several initial starting groups since the study was no longer randomized by the time it was completed.


Who took involved in the research that was done?




It is significant that 25 percent of the people who participated in the research were of African descent because in the past, people of color have historically been underrepresented in clinical trials. White people made up the majority of the other participants. The ages ranged from forty to eighty years old (the average was 55). All of the subjects had normal eye tests, normal vision, and an eye anatomy known as open angles, with the exception of those who had ocular hypertension. Glaucoma did not exist in any of the patients’ pasts.
Has the current perspective on when to begin treating glaucoma been altered as a result of this research?




At first look, the data compiled over a five-year period gave the impression that persons of African descent had a higher incidence of glaucoma compared to people of other races. However, when the researchers adjusted for significant parameters such as age, thickness of the cornea, a measurement that is called optic nerve cup size, and initial peripheral vision test scores, this apparent difference disappeared.



It came out that eye pressure and race were not the only factors that determined glaucoma risk; rather, the risk was determined by a combination of the data from the exam. Clinicians can use this information as a reference to determine if a person with ocular hypertension has a low, medium, or high risk of getting glaucoma. If patients had access to this kind of information, it might be easier for them to determine when they should start using medicated eye drops to either stop vision loss or reduce its progression.
What are some of the restrictions that apply to this extended research project?



The study has many drawbacks, including the following:

Trial participants typically adhere to their meds and appointments better than those who are not participating, which may cause the rates of glaucoma to be higher in the real world than those that were observed with either group in the trial.


During the first five years of the OHTS, participants were randomly assigned to either of two groups; however, during subsequent phases, both groups had access to eye pressure-lowering medication. At the age of 20, the majority of participants were already utilizing these medications; around 81% of those in the medication group and 66% of those in the control group were doing so. Because of this, it is difficult to evaluate how each starting strategy will fare in the long run.


The diagnosis of glaucoma has been more accurate over the years thanks to the development of novel diagnostic procedures like ocular coherence tomography and the identification of previously unknown risk factors like corneal hysteresis. This would provide even more credence to the idea that watchful waiting is a sensible choice for persons who are at a lower risk developing glaucoma as a result of a combination of variables.

People who already have glaucoma or other eye illnesses, as well as people who have an eye anatomy known as having narrow angles, are excluded from the applicability of the study’s findings.

What should we take away from this?



In general, the outcomes of the 20-year follow-up study provide credence to the idea that persons who have ocular hypertension should make their decisions on preventative glaucoma medicine on a mix of additional exam findings. People who have a greater number of risk factors, including higher eye pressures, older ages, thinner corneas, larger optic nerve cup sizes, and worse initial peripheral vision test scores, have a greater likelihood of developing glaucoma. Other risk factors include larger optic nerve cup sizes and worse initial peripheral vision test scores.

Eye pressure-lowering eye drops or a fast office treatment called as selective laser trabeculoplasty can help prevent glaucoma in those who have ocular hypertension, particularly when accompanied with a number of other risk factors. If you have ocular hypertension but not many other additional risk factors, you may be able to put off treatment for glaucoma as long as you undergo routine screenings to look for warning symptoms of the disease at an earlier stage. But because glaucoma is frequently asymptomatic, everyone who has ocular hypertension should have lifelong monitoring performed regardless of whether or not they are receiving therapy for the condition.


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