Ocular hypertension (OHT)

This is defined as consistently or recurrently elevated IOP (greater than 21 mmHg) in the absence of clinical evidence of optic nerve damage or visual field defect.

Knowledge of corneal thickness is no longer needed to decide whether or not to treat OHT and a single threshold of 24 mmHg is now recommended for both onward referral and treatment (1)

Notes:

• the NICE committee agreed that the key outcome for adults with ocular hypertension (OHT) or chronic open angle glaucoma (COAG) was visual field progression that, in the long-term, could affect people's vision (2)
  • intraocular pressure (IOP) was considered to be a relevant surrogate outcome because lowering IOP can prevent the risk of optic nerve damage and sight loss
  • high-quality evidence showed that there is no meaningful difference between 360 degrees selective laser trabeculoplasty (SLT) and eye drops in achieving a target IOP, health-related quality of life, risk of total adverse events, and treatment adherence
  • highlighted that there are rare complications associated with SLT
    • while rare events were not highlighted in the evidence, corneal failure is possible after SLT procedures
  • in people who have first-line treatment with eye drops compared with first-line 360 degrees SLT, more people used eye drops and more people have more than 1 eye drop medication at 12 months
  • cost-effectiveness evidence showed that first-line treatment with 360 degrees SLT was more effective and less costly compared with eye drops, with at least 90% probability of being the more cost-effective option
  • based on this evidence and their clinical experience, the committee recommended 360 degrees SLT as first-line treatment for people with newly diagnosed OHT or newly diagnosed COAG
    • recommendation excludes cases associated with pigment dispersion syndrome
      • was because there was no evidence on the use of 360 degrees SLT in people with pigment dispersion syndrome and the committee agreed that eye drop treatment is more suitable for those people

Reference:

• 1 NICE (November 2017). Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension
• 2 NICE (January 2022).Glaucoma: diagnosis and management