Case study: Adapting to change

In a recent article on hysteresis (Optician 08.03.2019), I described a patient with contact tonometry readings suggesting ocular hypertension.

Case to consider

These were the key findings:

History:

Presentation of right eye today:

Plan:

I asked, would you agree with this approach?

Key information

So with regard to the updated NG81 guidance¹ and the College of Optometrists guidelines relating to ocular hypertension,² the key points to consider are as follows:

Other factors to consider include:

Based on this presentation, reassessment in 18 to 24 months would be acceptable.¹

Discussion

This case represents a not uncommon presentation of ocular hypertension. Ocular hypertension (OHT) is generally defined as an elevated intraocular pressure (IOP) (greater than 21mmHg) as measured by Goldmann applanation tonometry (GAT) in one or both eyes in the absence of clinical evidence of optic nerve damage, visual field defect or other pathology that could explain high IOP.2 The prevalence for OHT ranges from 4.5% to 9.4% in the population aged over 40 years, carrying a 10% risk of conversion to primary open angle glaucoma within five years.²