Ocular hypertension

Ocular hypertension is the presence of elevated fluid pressure inside the eye (intraocular pressure), usually with no optic nerve damage or visual field loss.[1][2]

Not to be confused with Ocular hypotension.
Ocular hypertension
SpecialtyOphthalmology

For most individuals, the normal range of intraocular pressure is between 10 mmHg and 21 mmHg.[3][4] Elevated intraocular pressure is an important risk factor and symptom of glaucoma. One study found that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma.[5] Accordingly, most individuals with consistently elevated intraocular pressures of greater than 21mmHg, particularly if they have other risk factors, are treated in an effort to prevent vision loss from glaucoma.

Treatment, by lowering the intraocular pressure, may help decrease the risk of vision loss and damage to the eye from glaucoma. Treatment options include pressure-lowering 'antiglaucomatous' eye drops, surgery, and/or laser eye surgery.[6]

It is estimated that approximately 2-3% of people aged 52-89 years old have ocular hypertension of 25 mmHg and higher, and 3.5% of people 49 years and older have ocular hypertension of 21 mmHg and higher.[6]

Pathophysiology

The pressure within the eye is maintained by the balance between the fluid that enters the eye through the ciliary body and the fluid that exits the eye through the trabecular meshwork.[7]

Diagnosis

The condition is diagnosed using ocular tonometry and glaucoma evaluation. Increased IOP without glaucomatous changes (in optic disc or visual field) is considered as ocular hypertension.[7]

Treatment
Main article: Glaucoma medication

Ocular hypertension is treated with either medications (eye drops), surgery, or laser.

Medications that lower intraocular pressure work by decreasing aqueous humor production and/or increasing aqueous humor outflow. Eye drop formulations often include different combinations of beta-blockers, prostaglandin analogs (for example, latanoprost, travoprost, and bimatoprost), diuretics, and alpha-agonists.[6]

Laser trabeculoplasty works by increasing outflow. Laser treatment may be more effective than medications for decreasing the speed of loss of the visual field in people who have open-angle glaucoma.[8] Evidence suggests that laser treatment may have the same degree of effectiveness at decreasing intraocular pressure.[8]

Cannabis is not suggested for treatment of glaucoma by the American Glaucoma Society for adults or for children.[9][10]

Research

The LiGHT trial compared the effectiveness of eye drops and selective laser trabeculoplasty for ocular hypertension and open angle glaucoma. Both treatments contributed to a similar quality of life but most people undergoing laser treatment were able to stop using eye drops. Laser trabeculoplasty was also shown to be more cost-effective.[11]

Rho-Kinase inhibitors (for example, netarsudil) may be effective at decreasing ocular hypertension, however, how effective this medication is and longer term effects of these drops are not clear.[6]

References
  1. "Ocular Hypertension, Glaucoma & Eye Drops" (PDF). American Academy of Ophthalmology. June 2002. Archived from the original (PDF) on 25 November 2005.
  2. "Ocular Hypertension". American Optometric Association.
  3. "Tonometry". webMD.
  4. "Glaucoma Overview". eMedicine. Archived from the original on 2008-07-04. Retrieved 2005-12-28.
  5. Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, et al. (June 2002). "The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma". Archives of Ophthalmology. 120 (6): 701–713. doi:10.1001/archopht.120.6.701. PMID 12049574.
  6. Clement Freiberg, Josefine; von Spreckelsen, Alexander; Kolko, Miriam; Azuara-Blanco, Augusto; Virgili, Gianni (2022-06-10). Cochrane Eyes and Vision Group (ed.). "Rho kinase inhibitor for primary open-angle glaucoma and ocular hypertension". Cochrane Database of Systematic Reviews. 2022 (6). doi:10.1002/14651858.CD013817.pub2. PMC 9185806. PMID 35686679.
  7. Salmon, John F. (2020). "Glaucoma". Kanski's clinical ophthalmology : a systematic approach (9th ed.). Edinburgh: Elsevier. ISBN 978-0-7020-7713-5. OCLC 1131846767.
  8. Rolim-de-Moura, Christiane R; Paranhos Jr, Augusto; Loutfi, Mohamed; Burton, David; Wormald, Richard; Evans, Jennifer R (2022-08-09). Cochrane Eyes and Vision Group (ed.). "Laser trabeculoplasty for open-angle glaucoma and ocular hypertension". Cochrane Database of Systematic Reviews. 2022 (8). doi:10.1002/14651858.CD003919.pub3. PMC 9361429. PMID 35943114.
  9. Grossman, Adriana L.; Javitt, Matthew J.; Moster, Steven J.; Grajewski, Alana L.; Beck, Allen D.; Blieden, Lauren S.; Bitrian, Elena; Chang, Ta C.; Freedman, Sharon F.; Hodapp, Elizabeth; Joos, Keren M.; Reiser, Bibiana J.; Tanna, Angelo P. (2019-11-01). "American Glaucoma Society Position Statement on Cannabinoid Use in Pediatric Glaucoma Patients". Ophthalmology Glaucoma. 2 (6): 365–366. doi:10.1016/j.ogla.2019.07.007. ISSN 2589-4196.
  10. Jampel H (February 2010). "American glaucoma society position statement: marijuana and the treatment of glaucoma". Journal of Glaucoma. 19 (2): 75–76. doi:10.1097/ijg.0b013e3181d12e39. PMID 20160576.
  11. Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, et al. (April 2019). "Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial". Lancet. 393 (10180): 1505–1516. doi:10.1016/S0140-6736(18)32213-X. PMC 6495367. PMID 30862377.; Lay summary in: "A laser eye procedure can be effective and safe if used early as treatment for glaucoma". NIHR Evidence. National Institute for Health and Care Research. 4 June 2019. doi:10.3310/signal-000774. Plain English summary
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