In glaucoma suspects with IOP less than 22 mmHg and three or more risk factors, what is the recommended management?

• A. Observe Indefinitely
• B. Initiate Therapy And Monitor As Well
• C. Perform Laser Therapy Preemptively
• D. Start Therapy Only If IOP Rises Above 30

Answer: (B)

In glaucoma suspects with multiple risk factors, the goal is to reduce the chance of developing glaucoma even when the IOP isn’t high. Lowering IOP decreases stress on the optic nerve and can slow or prevent damage, which is why starting therapy now makes sense when three or more risk factors are present. At the same time, ongoing monitoring is essential to track the treatment’s effect and detect any early signs of progression through optic nerve assessment and visual fields, adjusting therapy as needed. Observing alone leaves the eye vulnerable to silent progression, and waiting for IOP to rise to a high level means missing the window to protect the optic nerve. Laser therapy can be used later or in specific situations, but the safest initial approach for high-risk suspects is to begin treatment while you continue diligent monitoring.