Ocular hypertension
Ocular hypertension means the pressure inside your eye is higher than normal, but your optic nerve is healthy, your side vision is full, and your scans are normal.
These are the questions people most often ask about it in clinic.
So do I have glaucoma or not?
No. This is the question almost everyone asks first, and the answer is no.
Ocular hypertension is a risk factor for developing glaucoma in the future, in much the same way that raised cholesterol is a risk factor for heart trouble. It is not the disease itself, and many people with it never go on to develop glaucoma at all.
Will I get glaucoma?
Probably not, but it is worth watching.
A large study followed people with raised pressure and healthy optic nerves for several years. Around one in ten of those left untreated developed glaucoma within five years. Treating the pressure roughly halved that. So most untreated people did not develop glaucoma during that time.
Your own risk depends on more than the pressure reading alone:
- How high the pressure actually runs
- The thickness of your cornea, which is one of the strongest predictors
- Your age
- The appearance of your optic nerve
- Whether there are any early irregularities on your visual field test
Two people given the same label can be in quite different positions. This is why the answer to "what are my chances?" is a conversation rather than a single number.
Why aren't you treating me?
Because for many people, treatment would do more harm than good.
Drops are a daily commitment for the rest of your life. They cost money, they can cause side effects, and most people with ocular hypertension were never going to develop glaucoma anyway. Starting someone on decades of treatment to prevent something unlikely to happen is not automatically the right call.
If your risk is higher, treatment makes clear sense and will be offered. If it is lower, careful monitoring is the better option. Either way it is a decision made together, once you understand where you sit.
Is there an alternative to drops if I do need treatment?
Yes. SLT laser is worth considering as a first option rather than drops. It lowers the pressure by a similar amount and removes the daily routine entirely. It takes about five minutes per eye in the clinic.
How often will I need to come back?
Usually every six to twelve months, sometimes more often if your risk is higher.
Each visit repeats the pressure check, an examination of the optic nerve, and an OCT scan. Visual field tests are done from time to time.
Why keep coming if nothing is wrong?
Because it is the trend that matters, not any single visit.
A nerve fibre layer that is thinning slightly year on year tells us something that no one appointment can. The tests are only useful when they can be compared.
Honestly, the most common way ocular hypertension causes harm is not the pressure at all. It is people quietly dropping out of follow-up because nothing ever seemed to be happening. If you move house or change optometrist, please make sure someone is still keeping an eye on this.
Does my steroid inhaler matter?
It can, and this catches people out.
Steroids can raise eye pressure, and that includes inhalers, nasal sprays, skin creams, joint injections and eye drops, not only tablets. Tell any doctor prescribing steroids that you have raised eye pressure, and if you need a long course, ask for your pressure to be checked while you are on it.
This does not mean stopping anything. It means telling the person who prescribes it.
Should my family be checked?
Yes. Raised pressure and glaucoma both run in families.
Your brothers, sisters and children should have their eyes tested and should mention the family history when they do. It is one of the most useful things you can do after your own diagnosis.
Is there anything I can do myself?
Keep up your routine sight tests. A good optometrist will pick up change between hospital visits.
Beyond that, there is no diet or exercise that reliably lowers eye pressure. Be wary of anything sold on that promise.
Next steps
Patients — contact the clinic to arrange an appointment.
GPs and optometrists — refer directly to Limerick or Ennis, including by Healthmail.