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June 13, 2011

Ocular Hypertension and Normal-Tension Glaucoma: Time for Banishment and Burial

Arch Ophthalmol. 2011;129(6):785-787. doi:10.1001/archophthalmol.2011.117

Let me begin with a simple, declarative conclusion: ocular hypertension and low-/normal-tension glaucoma are not clinical entities. They are meaningless statistical constructs that have done more to confuse the diagnosis and management of primary open-angle glaucoma (POAG) than they ever did to enhance it. It is time these terms were put to permanent rest.

How did these terms come about? Von Graefe concluded that all glaucomatous optic disc “excavation” was associated with high intraocular pressure (IOP), based on the only instrument then available for measuring IOP, digital palpation.1 Not until nearly a century later were reliable instruments used to measure the IOP of patients with characteristic glaucomatous optic nerve damage and of representative samples of older, European-derived populations.2-5