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October 12, 2009

Progressive Optic Disc Change: Implications for Clinical Practice and Trial Design

Arch Ophthalmol. 2009;127(10):1382-1383. doi:10.1001/archophthalmol.2009.281

Ocular hypertensive patients without convincing evidence of glaucomatous visual field defects with standard automated perimetry often present a dilemma for clinicians. After 5 years of follow-up the Ocular Hypertension Treatment Study showed that while reducing intraocular pressure (IOP) halved the relative risk of developing glaucoma (from 9.5% to 4.4%), the absolute risk reduction was only 5%, with around 90% of the subjects randomized to only observation not developing glaucoma.1 The Ocular Hypertension Treatment Study demonstrated the potent role of IOP in the development of glaucoma, yet it also highlighted that risk profiling for factors in addition to IOP was necessary to more accurately predict which subjects were likely to develop glaucoma and who required change in management, especially regarding treatment and frequency of follow-up. We have subsequently learned that older age, larger vertical cup-disc ratio, increased pattern standard deviation, and thinner central corneal thickness are additional risk factors,2,3 and efforts have been made to develop and validate risk models in ocular hypertension.3-8

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