How should ocular hypertension with IOP greater than 30 mmHg be managed?

• A. Primary SLT Is A Great Option
• B. Observation
• C. Prostaglandin Analog Start Only
• D. Surgical Trabeculectomy Is First Line

Answer: (A)

When ocular hypertension reaches an IOP above 30 mmHg, lowering the pressure promptly is important to reduce the risk of developing glaucomatous damage. Selective Laser Trabeculoplasty (SLT) offers a practical way to do this. SLT improves outflow through the trabecular meshwork, typically lowering IOP by about a quarter to a third, and it can be done in an office setting with minimal downtime. It’s noninvasive, relatively safe, and can be repeated if IOP rises again, making it a strong option to initiate treatment rather than waiting or relying solely on daily eye drops.

Observation isn’t ideal here because the very high pressure increases risk. Prostaglandin analogs are effective but require ongoing daily dosing and adherence, which can be a challenge. Surgical trabeculectomy is a more invasive step reserved for cases where laser or medication therapy fails or in advanced disease. Therefore, starting with SLT is a sensible, efficient way to reduce high IOP in ocular hypertension.