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    Why 'the more the merrier' doesn't apply to glaucoma monitoring

    Though ocular hypertension may be the only modifiable risk factor for glaucoma, the second-leading cause of sight loss in the United Kingdom, monitoring for ocular hypertension more than twice a year is not efficient, researchers said.

     “We find no clear benefit in terms of cost-effectiveness from intensive monitoring of people with ocular hypertension to detect glaucoma,” reported researchers from the University of Aberdeen, University of St. Andrews, and New Castle University. They published the finding in the British Journal of Ophthalmology.

    Related: Easier ways to identify compromised corneas

    But guidelines of the UK National Institute for Health and Care Excellence (NICE) calling for long-term monitoring of ocular hypertension have raised the concern that they might “overwhelm healthcare and patients,” they wrote.

    To test the efficacy of this kind of monitoring, they developed a model to simulate a cohort of 10,000 people in the United Kingdom with confirmed ocular hypertension defined as an IOP over 21 mm Hg and no clinical signs of glaucoma.

    Five scenarios were compared for monitoring and treating IOP:

    1)    Biennial Secondary: Monitoring twice a year in an eye-care setting led by a consultant. Treatment with prostaglandin analogue initiated when the baseline risk of glaucoma was at least 6% based on a 5-year risk estimator (Ophthalmology. 2008; 115:2030-2036). Responsiveness assessed at 2 months with less than a 15% reduction in IOP prompting the addition of a topical beta-blocker.

    2)    Biennial Primary: Monitoring twice a year in primary care led by a glaucoma-trained optometrist or general practitioner. Treatment as in scenario 1.

    3)    Treat All: Monitoring annually by a community optometrist. Treatment initiated without reference to glaucoma risk stratification. Treatment per NICE guidelines (based on age, central corneal thickness (CCT) and IOP).

    4)    NICE Intensive: Monitoring every 4 to 12 months by a glaucoma-accredited professional in either a consultant-led hospital or community optometry. Treatment as in scenario 3.

    5)    NICE Conservative: Monitoring every 6 to 24 months. Treatment as in scenario 3.

    Results of the study

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