For high-risk OHTN (>15%), what level of IOP reduction is recommended?

• A. 10% IOP reduction
• B. 20% IOP reduction, more for highest risk
• C. 30% IOP reduction
• D. No reduction

Answer: (B)

In ocular hypertension, lowering the IOP reduces the risk of progressing to glaucoma, so the target becomes bigger with higher risk. For high-risk OHTN, aiming for about a 20% reduction in IOP from the baseline is a practical and effective goal. This level provides meaningful risk reduction while typically being achievable with first-line treatments. If the patient has especially high risk factors—such as a thin cornea, suspicious optic nerve, strong family history, or older age—clinicians may push for a greater reduction, approaching or exceeding 25-30%, as tolerated, to maximize protection. A smaller reduction like 10% is unlikely to meaningfully cut progression risk in high-risk individuals, and not reducing at all ignores the elevated risk. A 30% target can be appropriate in some cases, but the standard starting goal for high-risk ocular hypertension is around 20%, with greater reduction considered for the highest risk.