THE COURSE OF UNTREATED OCULAR HYPERTENSION

It is still not certain what happens when ocular hypertension is left alone, despite the great amount of research that has been done on the subject. Nearly every case is treated as soon as it is discovered, and no one has been able tc study the development over a long period of time in a representative sample of untreated cases. Leydhecker (8) studied the development over three years in a group of whom 40 per cent had not been treated, but he only reported what happened to the ocular function during these years, nothing about the ocular tension. Chandler (4) reported that he had observed cases in which a tension of 30 mm. had not risen {though the patient had not been treated for years. In 1958 Armaly began an investigation of a representative sample (altogether 679 persons) of the population, which was planned to take five years: so far he has “dealt with the simultaneous presence of tonometric predictors and a defined arcuate scotoma” (1 , 2). The general opinion, dating back to Donders according to Haffmans in 1862 (5), is that ocular hypertension nearly always gets worse and worse, at any rate glaucoma simplex; Sugar (13) said that the tension rose gradually from a little over 24 mm. Hg up to 40 mm. Hg, sometimes to as high as 60 mm. Hg (Schiotz 1955 scale). Ballintine (3), on the other hand, observed that the intraocular pressure was only moderately elevated in persons who had grown blind from glaucoma after having refused treatment for religious reasons. In 1962 one of us (Stromberg (12)) reported the results of a mass survey of the ocular tension in the population over 40 years of age of a (town where