How should we treat ocular hypertension?

• A. Follow OHTS treatment guidelines, add in risk factors, treat high risk OHTN (remember a thinner cornea increases the risk of developing glaucoma)
• B. Rely on IOP alone
• C. Treat all eyes with high IOP regardless of risk
• D. Do nothing until symptoms appear

Answer: (A)

The idea is to manage ocular hypertension by estimating each eye’s risk of developing glaucoma, not by the IOP number alone. The OHTS showed that treatment can lower the chance of progressing to POAG in eyes with ocular hypertension, but the benefit is greatest in those with higher risk features. So you evaluate factors beyond IOP—central corneal thickness (CCT), age, the appearance of the optic nerve (cup-to-disc ratio), family history, and even race/ethnicity—and use them to estimate how likely glaucoma is to develop. A thinner cornea is an important risk factor because it’s associated with greater likelihood of progression to glaucoma, and it also can influence IOP measurements, making the risk assessment more complex. Based on this risk, you treat high-risk ocular hypertension to lower the IOP and reduce conversion risk; eyes with ocular hypertension but low risk are often monitored with regular follow-up rather than medicating. This approach mirrors following the OHTS guidelines and using risk factors to decide who needs treatment.