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Translating the OHTS Results into Clinical Practice

The release of the results of the Ocular Hypertension Treatment Study (OHTS) ushers in a new era in the evaluation and management of ocular hypertension and lays a new foundation upon which future discussions of ocular hypertension will be based. The tenets of evidence-based medicine would dictate that we must now decide if and how the 5-year results of this prospective, randomized, controlled clinical trial should influence our clinical practice. The primary aims of OHTS were to determine if a 20% reduction in intraocular pressure (IOP) in ocular hypertensive eyes, without structural evidence of glaucomatous optic neuropathy or functional deficits on conventional perimetry, prevents or delays the onset of glaucoma, compared with untreated controls, and to identify factors that increased the risk of conversion to glaucoma. The strengths of OHTS include strict adherence to inclusion and exclusion criteria, rigorous pre-enrollment testing, longitudinal assessment, impressive patient retention, and endpoint determinations made by masked reading centers and committees. To summarize the massive amount of work involved in this study in a single sentence may seem a bit unfair, but simply put, untreated subjects developed glaucoma at twice the rate of treated subjects at 5 years (9.5% vs. 4.4%). Based on these results, some may be inclined to suggest that all individuals with ocular hypertension be treated. Careful reading and assessment of the OHTS study design and results suggest that this “one size fits all” approach is incorrect and potentially harmful.