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Study results show visual field loss may be an early sign of ocular hypertension


A new light shines on the management of patients with ocular hypertention

Although treating intraocular pressure (IOP) is important for preventing vision loss, it is not always necessary for some patients, results from a new study show.

In the randomized, controlled, Ocular Hypertension Treatment Study (OHTS), the incidence of primary open-angle glaucoma (POAG) was analyzed in over 16,000 participants with ocular hypertension. Results showed that the risk of visual field loss remained constant over the 20-year study period.1

Study phases

In the first phase, participants were given topical ocular hypotensive medication or close observation for ocular hypotensive disorder. In the second phase, they were given medication, and in phase 3, they were given visual function tests and ophthalmic examinations.1

Related: IOP-lowering medication review

Phase 3 data collected over 20 years revealed that about 30% of participants developed POAG in one or both eyes. The twenty-year cumulative incidence rate of POAG was 48% in all participants, 44% in those who were only observed, and 38% in those who received medication.

By 20 years, the overall cumulative incidence of visual field loss was 25% among study participants.

This study’s findings suggest visual field loss may be an early sign of ocular hypertension.

It aims to provide a predictive model and a personalized treatment plan for patients with the condition and may help inform ODs and their patients about appropriate treatments.

Related: How one OD encouraged glaucoma medication adherence

Expert weighs in

Optometry Times® asked Chief Optometric Editor Benjamin Casella, OD, FAAO, to weigh in on the study’s results. Dr. Casella says the study advances valuable information for ODs.

“Retrospective analyses of landmark studies are so important in that they shape our understanding of disease progression over time,” says Dr. Casella. “The fact that only about 25% of the patients in this cohort progressed on visual field studies will aid in shedding light on those ocular hypertensives who do not require IOP-lowering therapy.”


1. Kass MA, Heuer DK, Higginbotham EJ, et al. Assessment of cumulative incidence and severity of primary open-angle glaucoma among participants in the ocular Hypertension Treatment Study After 20 years of follow-up. JAMA Ophthalmol. 2021;139(5):558-566. doi:10.1001/jamaophthalmol.2021.0341

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