Version 9 (23.09.09)
Condition
Aetiology
Ocular Hypertension
COMMENTS from Jane Bell
Ocular hypertension (OHT) is defined as consistently
elevated intraocular pressure (greater than 21mmHg on 2
or more occasions) in one or both eyes in the absence of
clinical evidence of optic nerve damage or visual field
defect
Aetiology unknown
Affects 3-5% of those over 40 years
Predisposing
factors
Symptoms
Signs
Data from longitudinal studies indicates that 10% of
persons with untreated OHT develop primary open angle
glaucoma (POAG) in 5 years
Increasing age
Usually asymptomatic
An untreated IOP >21mmHg, in one or both eyes
confirmed on a separate occasion
Open drainage angles on gonioscopy with normal
appearance
Absence of signs of glaucomatous optic neuropathy (disc
changes, field defects)
Differential
diagnosis
Absence of secondary cause for IOP elevation
Primary Open Angle Glaucoma (POAG)
Primary Angle Closure (PAC) (i.e. without glaucomatous
disc damage)
Secondary Open Angle glaucoma (e.g. steroid responder,
pigment dispersion, pseudo-exfoliation)
See relevant Clinical Management Guidelines
Version 9 (23.09.09)
Management by Optometrist
NonDiagnosis: diagnosis of OHT and formulation of a
pharmacological management plan can be made by a suitable trained
optometrist with a specialist qualification (when not
working under the supervision of a consultant
ophthalmologist) and relevant experience.
Pharmacological
Management
category
COMMENTS
What specialist qualification will be
required?
All patients with OHT should be offered the following tests:
IOP measurement using Goldmann applanation tonometry,
gonioscopy, central corneal thickness measurement, visual
field measurement using standard automatic perimetry and
optic disc assessment (NICE recommendation)
Gonioscopy and pachymetry are only
required for diagnosis not monitoring
Follow up management: people with confirmed OHT can
be monitored by optometrists with a specialist qualification
(when not working under the supervision of a consultant
ophthalmologist) and relevant experience (NICE
recommendation)
Optometrists with a specialist qualification (when not
working under the supervision of a consultant
ophthalmologist) and relevant experience can manage
OHT (including the prescription of ocular hypotensive
drugs) (NICE recommendation)
Diagnosed OHT can be monitored by all
optometrists as this requires GOC core
competencies
For specific management of OHT refer to NICE guideline
(see Evidence
For Optometrists without a specialist qualification when not
working under the supervision of a Consultant
Ophthalmologist:

B1 (modified): no intervention, routine referral to
Consultant Ophthalmologist
For Optometrists with a specialist qualification and relevant
experience (or working under the supervision of a
Or an optometrist with a specialist
qualification
Version 9 (23.09.09)
Consultant Ophthalmologist):
 B2: alleviation or palliation, no referral
Possible management by Ophthalmologist
Confirmation of diagnosis
Determination of the individual clinical management plan
Reduction of IOP pharmacologically in patients at
moderate or high risk of conversion to POAG
Evidence base
Kass MA, Heuer DK, Higginbotham EJ, Johnson CA,
Keltner JL, Miller JP, Parrish RK 2nd, Wilson MR, Gordon
MO. The Ocular Hypertension Treatment Study: a
randomized trial determines that topical ocular hypotensive
medication delays or prevents the onset of primary openangle glaucoma. Arch Ophthalmolol. 2002, 120:701-13.
Authors’ conclusion: Topical ocular hypotensive
medication was effective in delaying or preventing the
onset of POAG in individuals with elevated IOP. Although
this does not imply that all patients with borderline or
elevated IOP should receive medication, clinicians should
consider initiating treatment for individuals with ocular
hypertension who are at moderate or high risk for
developing POAG
Centre for Evidence-based Medicine Level of Evidence =
1a
For recommendations regarding OHT diagnosis and
management, refer to the NICE Guideline. Glaucoma:
diagnosis and management of chronic open angle
glaucoma and ocular hypertension
http://www.nice.org.uk/guidance/CG85
Or CRVO