Treating patients with ocular hypertension: preserving sight or a waste of resources?

Chicago-In a point-counterpoint debate, David L. Epstein, MD, Duke University Medical Center, Durham, NC, advocated treatment for most ocular hypertensive patients, drawing an analogy to treatment of systemic hypertension. Taking the opposite view, Paul R. Lichter, MD, University of Michigan, Ann Arbor, recommended treating only patients at high risk for ocular hypertension but noting that a key issue is deciding where to draw that line.

“Intraocular pressure is not some vague risk factor, it is a causative factor,” Dr. Epstein said, thus even moderately high IOP levels warrant intervention. In addition, visual field changes that may occur as disease progresses affect quality of life, and declining to treat certain patients violates the “golden rule” of treating others as you would treat your own eyes, he added.

Until methods of early detection improve, “we need to treat more patients rather than less,” he concluded.

Dr. Lichter recommended treating only high-risk patients, arguing that the financial burden, side effects, and inconvenience of medical therapy should not be inflicted on others. Instead, it is better to treat only those whose individual risk factors suggest that they face a high risk of conversion.

“There is not a shred of evidence that treating ocular hypertension is beneficial,” he said.

However, he urged that patients in the Ocular Hypertension Treatment Study continue to be followed so that additional data on their long-term outcome and disease progression can be evaluated to help clarify which patients should be treated and at what point.