When to treat ocular hypertension

Ocular hypertension (intraocular pressure ≥21 mm Hg, normal visual fields, normal optic discs, open angles, and the absence of any contributing ocular disease) occurs in 4-10% of the population over age 40. The question of whether to treat ocular hypertensive patients remains controversial. The author recommends prophylactic treatment for selected ocular hypertensive individuals who are at high risk of developing primary open angle glaucoma. The primary risk factors are high intraocular pressure, optic disc abnormality, increasing age, a family history of glaucoma, and systemic vascular disease. In addition, certain features of the patient's personality or medical condition favor treatment; for instance, treatment would probably be indicated in (1) a young patient, (2) a one-eyed patient, (3) an unreliable patient, (4) a patient who cannot do reliable visual fields or in whom the optic disc cannot be visualized, (5) a patient who prefers to be treated, and (6) a patient who has suffered a retinal vascular occulusion.