Recommendation ID

Treatment for people with an IOP of 22 or 23 mmHg:- What is the clinical and cost effectiveness of treating an intraocular pressure (IOP) of 22 or 23 mmHg in people with normal optic discs and visual fields?

Any explanatory notes
(if applicable)

Why this is important- The only proven intervention for preventing and controlling glaucoma is lowering IOP. It has been widely accepted that the upper limit of statistically normal IOP is 21 mmHg. This was also accepted as the threshold for treatment, and most treatment studies aimed to achieve this target or a reduction in IOP of between 25% and 35% from baseline. However, more recently the Ocular Hypertension Treatment Study (OHTS) enrolled people with an IOP between 24 mmHg and 32 mmHg, but without glaucomatous optic nerve damage, to receive treatment or no treatment. The results showed a reduction in 5-year incidence of very early glaucoma (either optic disc or visual field changes) from 9.5% in people not receiving treatment to 4.4% in those having treatment. This leaves an area of uncertainty about treatment for people with an IOP above 21 mmHg but below 24 mmHg. There are about 1.8 million people in the UK with an IOP of 22 or 23 mmHg. The costs associated with management in these people are sufficient to make this question of national importance.

Source guidance details

Comes from guidance
Glaucoma: diagnosis and management
Date issued
November 2017

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 30/11/2017