Under low-risk OHTN, is treatment mandatory or can monitoring suffice?

• A. Yes, immediately
• B. Sometimes if progression occurs
• C. No, can monitor without treatment
• D. Only if age over 80

Answer: (C)

In low-risk ocular hypertension, management is based on risk assessment rather than reflexively starting therapy. Many individuals with ocular hypertension never develop open-angle glaucoma, especially when their overall risk is low. While lowering IOP with treatment can reduce the chance of progression, the absolute benefit is smaller in low-risk patients, and eye drops come with costs, adherence challenges, and potential side effects. So, careful observation with regular follow-up is appropriate: repeat IOP measurements, optic nerve evaluations, imaging of the nerve fibers, and visual field testing to catch any signs of progression early. If new risk factors emerge or progression is detected, treatment can then be started. This approach balances the potential benefits of treatment against its burdens in those at low risk.