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Controversies
March 2004

We Should Treat Fewer Patients With Elevated Intraocular Pressure NowThat We Know the Results of the Ocular Hypertension Treatment Study

Arch Ophthalmol. 2004;122(3):378-379. doi:10.1001/archopht.122.3.378

The Ocular Hypertension Treatment Study (OHTS), a landmark trial inglaucoma therapy, has definitively answered the question "Does lowering intraocularpressure (IOP) in persons with elevated IOP but no glaucoma damage reducethe incidence of glaucoma?", confirming what most ophthalmologists knew—thattreatment works.

However, even the most ardent supporters of treatment to lower IOP wouldconcede that the results of the study do not suggest that all persons withocular hypertension should be treated.1,2 Afterall, only 9.5% of the subjects who were observed without therapy developedglaucoma during a mean follow-up period of 6 years. As the authors of thestudy themselves conclude in their article, "The results of the OHTS do notimply that all individuals with elevated IOP should be treated with ocularhypotensive medication."3(p708) Othersmay look at the OHTS results with a "number needed to treat" perspective4 and conclude that to prevent glaucoma damage in 1person with ocular hypertension, 20 persons need to be treated.

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