Ocular Hypertension Workup

Updated: Mar 16, 2020
  • Author: Anne Chang-Godinich, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Imaging Studies

Advances in computerized ocular imaging technology provide useful measures that can assist in glaucoma diagnosis and monitoring.

Imaging technologies such as confocal scanning laser ophthalmoscopy (eg, Heidelberg retina tomogram-HRT), scanning laser polarimetry (GDx), and optical coherence tomography (OCT) provide objective and quantitative measurements of retinal nerve fiber layer (RNFL) that are highly reproducible and show very good agreement with clinical estimates of optic nerve head structure and visual function. As with other technologies, imaging may produce false identification of glaucoma and its progression, thus management decisions should not be based solely on the results of one single test or technology. [49, 50]

In one prospective study of 24 matched eyes, Stratus OCT was found to detect significant differences in RNFL thickness between normal, ocular hypertensive, and glaucomatous eyes. [51]

In a longitudinal study of 857 eyes, the OHTS found HRT imaging to be as effective as stereophotographs for estimating risk of POAG development in ocular hypertensive patients. [52]

Current sensitivities and specificities in these modalities are continuing to improve.


Ultrasonographic Biomicroscopy

Ultrasonographic biomicroscopy (UBM) may prove helpful for obtaining a better view of the angle, iris, and ciliary body structures to rule out anatomic pathology and secondary causes of elevated IOP. [49]


Other Studies

Tonography, used to help determine trabecular outflow facility, is primarily a research tool used in testing pharmacologic agents. Fluorescein angiography, ocular blood flow analysis via laser Doppler flowmetry, color vision measurements, contrast sensitivity testing, and electrophysiologic tests (eg, pattern electroretinograms) currently are used as research tools in the management of ocular hypertension. Routine clinical use is not advocated at this time. [53]