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Mar 29 2006

From Ocular Hypertension to Glaucoma: How to Predict Conversion

posted by: J. James Thimons, OD, FAAO

The treatment of Ocular Hypertension in clinical practice is an area that has received significant attention in the last decade. The goal of these efforts has been to identify Risk Factors that mediate progression to glaucoma, allowing clinicians a clearer perspective on those patients that warrant intervention versus those that are best managed by monitoring.

Medeiros, FA et al., Arch Ophthalmol, 2005;123:1351-1360 has recently reviewed the validity of the risk of conversion derived in the Ocular Hypertension Treatment Study. In this analysis of 126 subjects over a 5 year period, the predictive value of older age, higher baseline IOP and thinner corneas were all significantly associated with an increased of progression to glaucoma. Baseline vertical cup/disc ratio and Pattern Standard Deviation were identified as relative risks for development of the disease.

Interestingly, the history of diabetes which was seen as protective factor in OHTS was not evident in this study and places into question the reliability of that data point in OHTS given that patients with diabetic retinopathy were excluded at baseline enrollment.

The ability to derive reliable indices to assist in identifying patients at risk for progression to glaucoma is a critical element in applying the concept of evidenced based medicine to our management of glaucoma. This study provides a firm confirmation of previously developed concepts in this area and should be integrated into clinical practice at all levels.