For glaucoma suspects with IOP <22 and three or more risk factors, which statement best describes management?

• A. Only Laser Therapy
• B. Do Nothing And Observe
• C. Initiate Therapy And Ongoing Monitoring
• D. Immediate Surgical Intervention

Answer: (C)

When deciding management for glaucoma suspects, the main idea is that risk of progression is driven by factors beyond just the current IOP. If someone has three or more risk factors, their chance of developing definite glaucoma increases even when IOP is below 22 mmHg. That’s why starting treatment to lower IOP, and pairing it with ongoing monitoring, is the most protective approach.

Lowering IOP helps reduce the stress on the optic nerve and the likelihood of conversion to glaucoma or progression of any existing nerve damage. A typical plan aims for a meaningful drop in IOP (often around 20–30% or more, individualized to the patient) and then follows with regular check-ins to track the optic nerve structure (via photos or OCT), the nerve fiber layer, and functional tests like visual fields. This ensures any early signs of progression are caught quickly and therapy is adjusted.

Immediate surgery isn’t the default for someone with a low-ish IOP but multiple risk factors, and doing nothing ignores the elevated risk. Laser therapy can be useful in some cases, but the best overall approach here is to initiate therapy and maintain vigilant monitoring, with the option to escalate care if progression is detected.