Intended for healthcare professionals


Screening for glaucoma using intraocular pressure alone

BMJ 2017; 358 doi: (Published 13 September 2017) Cite this as: BMJ 2017;358:j4160
  1. Henry D Jampel, Odd Fellows professor of ophthalmology
  1. Johns Hopkins Wilmer Eye Institute, 600 N Wolfe St, Baltimore, MD 21287-9205, USA
  1. hjampel{at}

An outdated concept that should be abandoned

In a linked paper, Chan and colleagues (doi:10.1136/bmj.j3889) report the distribution of intraocular pressure (IOP) and the frequency of glaucoma in the EPIC-Norfolk cohort, a community based cross sectional study of a UK population.1 With knowledge of both the distribution of IOP and the frequency of glaucoma, the authors determined that the diagnostic capability of IOP alone to detect glaucoma is poor. This conclusion is important because “Glaucoma and suspected glaucoma combined account for the sixth largest share of National Health Service (NHS) outpatient attendances. . .”.1 Since guidelines from the National Institute for Health and Care Excellence2 describe one of the features of chronic open angle glaucoma as “IOP in either eye exceeding 21 mm Hg,” referrals solely on the basis of IOP may be contributing to resource overuse.

Glaucoma, an optic neuropathy with a characteristic appearance of the optic disc and progressive vision loss, is a leading cause of blindness worldwide.3 The authors’ findings of a prevalence of 3-4% in a population aged 48 years or more, …

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