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Treatment not always needed to prevent vision loss in patients with elevated eye pressure

Landmark study shows most patients with elevated pressure don’t go on to lose vision
April 15, 2021
Doctor examines patient's eye

Michael A. Kass, MD, (right) led the national Ocular Hypertension Treatment Study to determine whether lowering elevated eye pressure in patients might prevent vision loss from glaucoma. Kass and colleague Mao O. Gordon, PhD, recently completed follow-up studies on patients 20 years after the start of the original study. Image credit: Washington University Medical School

More than 20 years after the launch of a landmark clinical trial, follow-up examinations and analyses found that not all patients with elevated eye pressure need pressure-lowering treatment to prevent vision loss from glaucoma.

When the study was launched, it was universally accepted that all patients with elevated eye pressure should be given medication to lower that pressure. The Ocular Hypertension Treatment Study — funded by the National Eye Institute of the National Institutes of Health (NIH) and led by researchers at Washington University School of Medicine in St. Louis — recruited more than 1,600 patients nationally who were at moderate to high risk for glaucoma because of elevated eye pressure. The purpose was to evaluate how successful medication was at preserving vision.

As reported online April 15 in the journal JAMA Ophthalmology, the researchers found that about 25% of study participants went on to develop vision loss from glaucoma in at least one eye, a lower rate than what was expected. 

“But treating elevated eye pressure can be expensive and inconvenient, so we wanted to determine whether all individuals with high pressure should be treated,” said Michael A. Kass, MD, the Bernard Becker Professor of Ophthalmology & Visual Sciences. “With only 25% of the individuals in the study developing vision loss in one or both eyes after all these years, we know now that not all of those patients needed to be treated.”