Ocular Hypertension

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Description: Ocular Hypertension diagnosis and referral management for community optometrists

Publet Introduction:

Glaucoma refers to a group of conditions with heterogeneous causes that result in damage to the optic nerve head and loss of visual field. There are typical optic nerve changes on slit-lamp examination. It is frequently - but not invariably - associated with raised intraocular pressure (IOP).

Glaucoma is usually associated with an increase in IOP above the normal value, which is usually estimated at 21 mm Hg (mean 15.5, range 10-21). Surveys show that 20-52% of patients with glaucoma have IOP within the normal range. Patients with statistically normal IOP who develop the characteristic changes associated with open-angle glaucoma are said to have low tension or normal pressure glaucoma.[1] 

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  Information
Guideline objectives

1. Diagnosis of Ocular Hypertension (OHT)

2. Referral management of patient

Target setting Primary care
Target users Community Optometrists
Overview

Ocular Hypertension is raised pressure within the eye. Ocular Hypertension is not Glaucoma, however patients with Ocular Hypertension are at increased risk of developing Glaucoma. Therefore they require careful monitoring to detect Glaucoma at its early stages and provide treatment.

Research has shown significant false positive referrals from optometry practices[1,2,3] to Hospital Eye Services (HES) and up to 45% of referrals to HES may have no evidence of Glaucoma or Ocular Hypertension [4]

This guideline-based clinical decision support system has been developed to assist community optometrists in diagnosis and management of OHT patients. 

Provenance 7.No provenance has been assigned (default value)
Management
  • Author: Gopikrishnan Chandrasekharan
  • Release date:
  • Status: Draft - Under Review
  • History: Edited on 14/3/2014
Safety case
Sources

1. Guidance on the referral of Glaucoma suspects by community optometrists: Issued by The College of Optometrists and The Royal College of Ophthalmologists

2. Ocular Hypertension-Clinical Management Guidelines: Issued by The College of Optometrists

3. Terminology and guidelines for glaucoma (3rd edition):Issued by European Glaucoma Society

4. Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension: Issued by National Institute for Health and Care Excellence (NICE)

5. Examining the patient at risk from glaucoma: Issued by The College of Optometrists

References

1. Bell, R. W. D. & O’Brien, C. Accuracy of referral to a glaucoma clinic. Ophthalmic and Physiological Optics 17, 7–11 (1997).

2. Theodossiades, J. & Murdoch, I. Positive predictive value of optometrist-initiated referrals for glaucoma. Ophthalmic and Physiological Optics 19, 62–67 (1999).

3. Bell, R. W. & O’Brien, C. The diagnostic outcome of new glaucoma referrals. Ophthalmic & physiological optics?: the journal of the British College of Ophthalmic Opticians (Optometrists) 17, 3–6 (1997).

4. Bowling, B., Chen, S. D. M. & Salmon, J. F. Outcomes of referrals by community optometrists to a hospital glaucoma service. The British journal of ophthalmology 89, 1102–4 (2005).