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Abstract

Background
Ocular hypertension, that is intraocular pressure > 21 mmHg, is a risk factor for glaucoma. A glaucoma risk predictor, the Ocular Hypertension Study–European Glaucoma Prevention Study model, is available.

Objectives
(1) To validate and update the Ocular Hypertension Study–European Glaucoma Prevention Study risk prediction model in a United Kingdom population; (2) to assess the relative efficiency of alternative monitoring pathways according to glaucoma risk; (3) to determine the clinical and cost-effectiveness of treating people with ocular hypertension with intraocular pressure of 22 or 23 mmHg and (4) to elicit patient preferences for monitoring.

Design
(1) Retrospective data analysis of electronic medical records of ocular hypertension patients attending hospital eye services. The influence of the Ocular Hypertension Study–European Glaucoma Prevention Study predictors and additional ocular and systematic factors was explored. Validation: the Ocular Hypertension Study–European Glaucoma Prevention Study prediction model was applied. Update: the model was refitted by re-estimating baseline hazard and regression coefficients. (2, 3) Predictor versus standard care, with deterministic and probabilistic sensitivity analyses. Subgroup analysis for people with 22–23 mmHg intraocular pressure. (4) Discrete choice experiment.

Setting and participants
People with intraocular pressure 22–32 mmHg in either eye, at least four visual field tests, 5 years of follow-up, no significant ocular comorbidities. Data sourced from secondary clinical settings.

Main outcome measures
Discriminative ability (c-index) and calibration (calibration slope) to predict conversion to glaucoma in 5 years. Quality-adjusted life-years, incremental cost-effectiveness ratio, preferences.

Data sources
Electronic medical records of 10 hospitals in England.

Results
(1) Of 9030 patients with ocular hypertension who fitted the inclusion criteria 1530 (16.9%) converted to glaucoma. The Ocular Hypertension Study–European Glaucoma Prevention Study model provided a pooled c-index of 0.61 (95% confidence interval: 0.60 to 0.63). The updated model had a pooled c-index of 0.67 (0.51 to 0.84). (2) In the economic model almost all (99%) patients were treated in the risk predictor strategy, and less than half (47%) in the standard care strategy. The risk predictor strategy produced higher costs, but also higher quality-adjusted life-years and is likely to be cost-effective compared with standard care. (3) Patients with ocular hypertension and intraocular pressure 22–23 mmHg had similar risk of conversion to the rest of the cohort. A treat-all strategy may not be cost-effective. (4) Three hundred and sixty patients were recruited from four NHS hospitals. Almost all respondents (92%) had experienced face-to-face monitoring at a hospital; fewer respondents had experienced virtual clinics (47%) or community optometrist monitoring (43%). Most patients preferred hospital-based monitoring services by health professionals rather than community-based by optometrists but patients with prior experience of community optometrist monitoring preferred it. Patients preferred options associated with lower risk of conversion and lower costs.

Limitations
Insufficient data to evaluate influence of ethnicity or ocular factors such as optic disc and retinal anatomy.

Conclusions
We validated the Ocular Hypertension Study–European Glaucoma Prevention Study predictor model in a large population with ocular hypertension achieving modest improvements. The use of a risk prediction tool is likely to be cost-effective. Reducing the risk of conversion was the most important preference for patients with ocular hypertension.

Future work
Future work should address the influence of genetic or other ocular factors in disease progression, evaluation of effectiveness and cost-effectiveness of different models of eye care, and on how to avoid late glaucoma presentation.

Funding
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR131808.

Publication Type:	Article
Additional Information:	Copyright © 2026 Wright et al. This work was produced by Wright et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.
Subjects:	R Medicine > RC Internal medicine R Medicine > RE Ophthalmology
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Optometry & Visual Science
SWORD Depositor:	Symplectic Administrator

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