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    Ocular Hypertension Treatment Study (OHTS) Calculator

    Identifies patients that may benefit from therapy to lower intraocular pressure (IOP).
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    When to Use
    Pearls/Pitfalls
    Why Use

    Use in an outpatient setting in patients 30-80 years old with ocular hypertension to assess need for initial treatment to reduce the likelihood of progression to glaucoma.

    • The original studies used patients with a baseline intraocular pressure (IOP) of 22 to 32 mmHg.

    • Not validated in patients under 30 years of age or over 80 years of age.

    • Primarily developed from studies looking at the early development of primary open angle glaucoma (POAG) and has little utility in later stages of glaucoma.

    • Patients with potential secondary causes of elevated IOP including pigment dispersion or pseudoexfoliation should be excluded, as well as patients with non-glaucomatous reasons for visual field loss.

    • There are other established risk factors for the development of POAG, and these should be taken into account separately.

    Aids in shared decision making with patients regarding whether to initiate treatment for ocular hypertension based on the five-year risk of progression to open angle glaucoma.

    30-44
    0
    45-54
    +1
    55-64
    +2
    65-74
    +3
    ≥75
    +4
    <22
    0
    22 to <24
    +1
    24 to <26
    +2
    26 to <28
    +3
    ≥28
    +4
    >600
    0
    576–600
    +1
    551–575
    +2
    526–550
    +3
    ≤525
    +4
    <0.3
    0
    0.3 to <0.4
    +1
    0.4 to <0.5
    +2
    0.5 to <0.6
    +3
    ≥0.6
    +4
    <1.8
    0
    1.8 to <2.0
    +1
    2.0 to <2.4
    +2
    2.4 to <2.8
    +3
    ≥2.8
    +4

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    • Patients with a score between 0-6 can be observed every 6 months.

    • Patients with a score between 7-12 should be counseled about the risks and benefits of starting treatment versus close observation.

    • Patients with a score >12 should strongly consider initiating treatment.

    Management

    • Initiation of IOP lowering therapy.

    • Close monitoring with visual field and optic nerve head imaging every 3-12 months, depending on specific patient parameters.

    Formula

    Addition of the selected points:

    Variable

    Points

    Age, years

    30-44

    0

    45-54

    1

    55-64

    2

    65-74

    3

    ≥75

    4

    Mean intraocular pressure*, mmHg

    <22

    0

    22 to <24

    1

    24 to <26

    2

    26 to <28

    3

    ≥28

    4

    Mean central corneal thickness*, µm

    >600

    0

    576–600

    1

    551–575

    2

    526–550

    3

    ≤525

    4

    Mean vertical cup-to-disc ratio by contour

    <0.3

    0

    0.3 to <0.4

    1

    0.4 to <0.5

    2

    0.5 to <0.6

    3

    ≥0.6

    4

    Mean pattern standard deviation**, dB

    <1.8

    0

    1.8 to <2.0

    1

    2.0 to <2.4

    2

    2.4 to <2.8

    3

    ≥2.8

    4

    *Mean of three measurements per eye.

    **2 measurements per eye of: Humphrey full threshold 30-2, SITA Standard 30-2 or 24-2, or loss of variance from Octopus 32-2.

     

    Facts & Figures

    Interpretation:

    OHTS Score

    5 year risk of developing POAG

    Risk - Recommendation

    0-6

    ≤4.0%

    Low - Recommend observation every 6 months

    7-8

    10%

    Intermediate - Recommend counseling on risks/benefits of treatment versus close observation

    9-10

    15%

    11-12

    20%

    >12

    ≥33%

    High - Recommend initiating treatment

    Evidence Appraisal

    Ocular Hypertension Treatment Study (2002): This randomized controlled trial evaluated 1,636 patients with ocular hypertension without glaucomatous field or optic nerve loss and found that lowering IOP was beneficial in preventing the progression to glaucoma. This study also identified clinical characteristics that predict the onset of primary open angle glaucoma.

    Data from the original OHTS group was pooled with data from the European Glaucoma Prevention Study (EGPS) group to develop with a model to predict five year progression to glaucoma based on characteristics identified in the original study.

    The OHTS/EGPS model has been validated in subsequent studies referenced below.

    Literature

    Dr. Michael A. Kass

    About the Creator

    Michael A. Kass, MD, is a professor of ophthalmology and chairman of the Department of Ophthalmology and Visual Sciences at Washington University in St. Louis. He is also the director of the Heed Ophthalmic Foundation. Dr. Kass’ primary research is focused on glaucoma, ocular hypertension, and esotropia.

    To view Dr. Michael A. Kass's publications, visit PubMed

    Content Contributors
    • Edmund Tsui, MD
    • Priya Patel, MD
    Reviewed By
    • Joshua Young, MD
    About the Creator
    Dr. Michael A. Kass
    Content Contributors
    • Edmund Tsui, MD
    • Priya Patel, MD
    Reviewed By
    • Joshua Young, MD