International Ophthalmology

, Volume 39, Issue 4, pp 803–812 | Cite as

Long-term evaluation of ocular hypertension with primary angle closure and primary open angles

  • Ramanjit Sihota
  • Harathy SelvanEmail author
  • Ajay Sharma
  • Amisha Gupta
  • Viney Gupta
  • Tanuj Dada
  • Ashish Datt Upadhyay
Original Paper



To evaluate the long-term course of primary angle-closure ocular hypertension and primary open-angle ocular hypertension and possible risk factors for progression to glaucoma.


A total of 109 eyes of 109 ocular hypertension (OHT) patients with a minimum follow-up period of 5 years having complete ocular/medical records were evaluated. They were classified into primary angle closure or primary open angle based on gonioscopy at baseline. Baseline and review data of Humphrey field analyser, HFA, and Heidelberg retinal tomography, HRT, were recorded. Guided progression analysis (GPA) and univariate Cox regression were used for time to event analysis in identifying progression to glaucoma.


Over a mean follow-up of 12.18 ± 4.8 years, progression to glaucoma was 17.43% (19 eyes), out of whom 5.5% (6 eyes) showed ≥ 3 loci on GPA. Sub-classifying them, progression to primary angle-closure glaucoma was 19.72%, and that of primary open-angle glaucoma was 13.16%. The mean time to progression was 9.34 ± 3.6 years. Significant risk factors included small disc area (≤ 1.99 on HRT), requirement of ≥ 2 drugs to maintain target IOP and those engaged in activities yielding a Valsalva effect in daily life. Coronary artery disease (CAD) and systemic use of steroids were associated with increased severity.


Overall progression of OHT to glaucoma was 17.43% over a mean of 9 years, with target IOP of ≤ 18 mm Hg. Patients with smaller discs, CAD, exercising Valsalva type activities and using ≥ 2 glaucoma medications or systemic steroids should be closely monitored.


Ocular hypertension Primary angle closure Progression Smaller discs Number of medications 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Human and animal rights

The procedures performed in this report involving human subject were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all the participants of this study.


  1. 1.
    Ramakrishnan R, Nirmalan PK, Krishnadas R et al (2003) Glaucoma in a rural population of southern India: the Aravind comprehensive eye survey. Ophthalmology 110:1484–1490CrossRefGoogle Scholar
  2. 2.
    Varma R, Ying-Lai M, Francis BA et al (2004) Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the Los Angeles Latino Eye Study. Ophthalmology 111:1439–1448CrossRefGoogle Scholar
  3. 3.
    Kass MA, Heuer DK, Higginbotham EJ et al (2002) The ocular hypertension treatment study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol Chic Ill 1960 120:701–713 (discussion 829–830) CrossRefGoogle Scholar
  4. 4.
    Sihota R (2011) An Indian perspective on primary angle closure and glaucoma. Indian J Ophthalmol 59:76CrossRefGoogle Scholar
  5. 5.
    Thomas R, Parikh R, Muliyil J et al (2003) Five-year risk of progression of primary angle closure to primary angle closure glaucoma: a population-based study. Acta Ophthalmol Scand 81:480–485CrossRefGoogle Scholar
  6. 6.
    Kim YY, Jung HR (1997) Clarifying the nomenclature for primary angle-closure glaucoma. Surv Ophthalmol 42:125–136CrossRefGoogle Scholar
  7. 7.
    Arnalich-Montiel F, Casas-Llera P, Muñoz-Negrete FJ et al (2009) Performance of glaucoma progression analysis software in a glaucoma population. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol 247:391–397CrossRefGoogle Scholar
  8. 8.
    Kass MA, Gordon MO, Gao F et al (1960) Delaying treatment of ocular hypertension: the ocular hypertension treatment study. Arch Ophthalmol Chic Ill 2010(128):276–287Google Scholar
  9. 9.
    Gordon MO, Gao F, Beiser JA et al (1960) The 10-year incidence of glaucoma among patients with treated and untreated ocular hypertension. Arch Ophthalmol Chic Ill 2011(129):1630–1631Google Scholar
  10. 10.
    Thomas R, Parikh R, George R et al (2003) Five-year risk of progression of ocular hypertension to primary open angle glaucoma. A population-based study. Indian J Ophthalmol 51:329–333Google Scholar
  11. 11.
    Medeiros FA, Sample PA, Weinreb RN (2003) Corneal thickness measurements and visual function abnormalities in ocular hypertensive patients. Am J Ophthalmol 135:131–137CrossRefGoogle Scholar
  12. 12.
    Chauhan BC, McCormick TA, Nicolela MT et al (2001) Optic disc and visual field changes in a prospective longitudinal study of patients with glaucoma: comparison of scanning laser tomography with conventional perimetry and optic disc photography. Arch Ophthalmol 119:1492–1499CrossRefGoogle Scholar
  13. 13.
    Fayers T, Strouthidis NG, Garway-Heath DF (2007) Monitoring glaucomatous progression using a novel Heidelberg Retina Tomograph event analysis. Ophthalmology 114:1973–1980CrossRefGoogle Scholar
  14. 14.
    Vizzeri G, Weinreb RN, Martinez de la Casa JM et al (2009) Clinicians agreement in establishing glaucomatous progression using the Heidelberg retina tomograph. Ophthalmology 116:14–24CrossRefGoogle Scholar
  15. 15.
    Sihota R, Sony P, Gupta V et al (2005) Comparing glaucomatous optic neuropathy in primary open angle and chronic primary angle closure glaucoma eyes by optical coherence tomography. Ophthalmic Physiol Opt J Br Coll Ophthalmic Opt Optom 25:408–415CrossRefGoogle Scholar
  16. 16.
    Hayamizu F, Yamazaki Y, Nakagami T et al (2013) Optic disc size and progression of visual field damage in patients with normal-tension glaucoma. Clin Ophthalmol Auckl NZ 7:807–813Google Scholar
  17. 17.
    Salvetat ML, Zeppieri M, Tosoni C et al (2016) Baseline factors predicting the risk of conversion from ocular hypertension to primary open-angle glaucoma during a 10-year follow-up. Eye Lond Engl 30:784–795Google Scholar
  18. 18.
    Landers J, Goldberg I, Graham SL (2002) Analysis of risk factors that may be associated with progression from ocular hypertension to primary open angle glaucoma. Clin Exp Ophthalmol 30:242–247CrossRefGoogle Scholar
  19. 19.
    Gupta V (2010) Constipation-related migraine is linked to the effect of the Valsalva maneuver on the eye: a case report and a mechanistic review. Accessed 4 Dec 2016
  20. 20.
    Sihota R, Dada T, Aggarwal A et al (2007) Does an iridotomy provide protection against narrowing of the anterior chamber angle during Valsalva maneuvre in eyes with primary angle closure. Eye 22:389–393CrossRefGoogle Scholar
  21. 21.
    Sihota R, Konkal VL, Dada T et al (2008) Prospective, long-term evaluation of steroid-induced glaucoma. Eye Lond Engl 22:26–30Google Scholar
  22. 22.
    Giraud J-M, May F, Manet G et al (2010) Analysis of progression with GPA (guided progression analysis) and mean deviation (MD) indexes of automated perimetry in ocular hypertension and glaucoma. Invest Ophthalmol Vis Sci 51:3997Google Scholar
  23. 23.
    Renard JPG, Giraud JM, Aryal-Charles N et al (2014) Progression of visual field in patients with ocular hypertension and primary open-angle glaucoma: PROG-F study1 Preliminary results. Invest Ophthalmol Vis Sci 55:5618Google Scholar
  24. 24.
    Delbarre M, Giraud J, Aptel F et al (2014) Analyze of visual field indices in ocular hypertension: PROG-F3 study. ResearchGate. (Epub ahead of print 1 September 2014) Google Scholar
  25. 25.
    Rao HL, Kumbar T, Kumar AU et al (2013) Agreement between event-based and trend-based glaucoma progression analyses. Eye 27:803–808CrossRefGoogle Scholar
  26. 26.
    Casas-Llera P, Rebolleda G, Muñoz-Negrete FJ et al (2009) Visual field index rate and event-based glaucoma progression analysis: comparison in a glaucoma population. Br J Ophthalmol 93:1576–1579CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Glaucoma ServicesDr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia

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