Modelled care pathways for monitoring confirmed OHT
| Pathway | Baseline risk stratification for treatment | Treatment allocation | Monitoring interval and type of monitoring |
|---|---|---|---|
| (i) Biennial review—Primary care (glaucoma-accredited optometrist or general practitioner) | 5-year glaucoma risk estimator10 | PGA initiated if 5-year glaucoma risk ≥6%* BB added if <15% reduction in IOP | Two yearly glaucoma assessment†8 If IOP off target or conversion to glaucoma detected refer to secondary care |
| (ii) Biennial review—Secondary care (consultant led) | 5-year glaucoma risk estimator10 | PGA initiated if 5-year glaucoma risk ≥6%.* BB added if <15% reduction in IOP | Two yearly glaucoma assessment†8 |
| (iii)‘Treat all’ | IOP >21 mm Hg No further risk stratification | PGA if IOP >21 mm Hg | IOP monitoring once a year in primary care optometry and no glaucoma assessment. If IOP <15% reduction from baseline refer to hospital eye care according to NICE OHT guideline6 |
| (iv) NICE informed—NICE intensive | NICE guideline (based on age, CCT and IOP, see online supplementary appendix table A1)6 | NICE guideline with modifications‡6 | NICE guideline. Using minimum intervals between monitoring visits6 |
| (v) NICE informed—NICE conservative | NICE guideline (based on age, CCT and IOP)6 | NICE guideline with modifications‡6 | NICE guideline. Using maximum intervals between monitoring visits6 |
*All those starting treatment or requiring a treatment change have two consecutive (same day) IOP within 2 months of starting or changing treatment.
†IOP, perimetry and optic nerve assessment.
‡People with CCT <555 µm and on a PGA are treated until either 65 years if 21 mm Hg <IOP ≤25 mm Hg or 80 years if 25 mm Hg <IOP <32 mm Hg. Untreated low-risk individuals (CCT >590 µm and IOP <32 mm Hg) with stable IOP are not discharged in our model and this is a deviation from the NICE guideline.
BB, beta blocker; CCT, central corneal thickness; IOP, intraocular pressure; NICE, National Institute for Health and Care Excellence; OHT, ocular hypertension; PGA, prostaglandin analogue.