Ocular hypertension, first risk factor for glaucoma

Ocular hypertension occurs when the pressure inside the eye is above the normal range, i.e. above 21mm Hg.

The fact that there is an increase in intraocular pressure, which is usually progressive with age but may also be due to other factors, is the first risk factor for developing glaucoma. Hence, people with ocular hypertension are more prone to suffer from this disease.

But they are different things: we speak of ocular hypertension when the intraocular pressure is high but the optic nerve is not damaged, whereas in glaucoma it is (and the intraocular pressure can be normal or high). The fact that the nerve is damaged may cause the patient to notice a loss of visual field and central vision, even in advanced cases.

Why does ocular hypertension occur?

Ocular hypertension is caused by a malfunction of the aqueous humor drainage system, which nourishes and bathes the structures of the eye. If this aqueous humor does not flow correctly, the balance between the liquid inside the eye and that which flows out of it is broken, which causes the intraocular pressure to increase in a process that is normally gradual, although it can also be sudden.

Are there groups more prone to suffer from ocular hypertension?

Anyone can suffer from ocular hypertension, but there are some groups that are more prone to suffer from it and, therefore, to develop glaucoma:

  • People with a family history of glaucoma or ocular hypertension.
  • Patients with diabetes.
  • People over 60 years of age.
  • People suffering from myopia or hyperopia.
  • Patients with trauma or ocular disease.
  • Asian or black people.
  • Patients who have a narrow ocular angle.
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Can ocular hypertension be prevented?

Ocular hypertension cannot be prevented, but it can be controlled with regular check-ups with an ophthalmology specialist, especially in patients with risk factors. In addition, ocular hypertension can be reduced with treatments to prevent damage to the optic nerve and, consequently, irreversible vision loss due to glaucoma.

How can we identify ocular hypertension and what are the symptoms?

The increase in intraocular pressure normally goes unnoticed by patients, since it does not manifest itself with any symptoms (except in acute glaucoma attacks, which cause intense pain). Therefore, the only way to detect ocular hypertension is to have a complete ophthalmologic examination, where the intraocular pressure value will be measured with tonometry.

Precisely, eye strain is one of the key aspects of glaucoma, as it is the main risk factor for the disease and because of the progressive damage it causes to the optic nerve. In fact, glaucoma usually has no symptoms, such as loss of peripheral vision, until very advanced stages. Likewise, the vision lost due to glaucoma cannot be recovered; its evolution can only be slowed down with medical and surgical treatments. For all these reasons, specialists recommend periodic check-ups to assess eye pressure and the state of the optic nerve.

How should ocular hypertension be treated?

Ocular hypertension should be treated in a 100% individualized manner. It can be with drugs (combinations and different types of eye drops), laser (trabeculoplasty) or different surgeries, in order to reduce intraocular pressure with the least possible impact on the patient:

  • Trabeculoplasty
  • Transscleral Cyclophotocoagulation with diode laser
  • Deep non-perforating sclerotomy
  • Drainage devices
  • Goniotomy
  • Iridoplasty
  • Iridotomy
  • Ocular hypotensors
  • MIGS (Minimally Invasive Glaucoma Surgery)
  • Trabeculectomy
  • Excimer Laser Trabeculostomy (ELT)