Which scenario best describes ocular hypertension?

• A. Normal IOP with no glaucoma damage
• B. Elevated IOP with no definitive glaucoma damage
• C. Elevated IOP with documented glaucoma damage
• D. Normal IOP with high risk factors

Answer: (B)

Ocular hypertension means elevated intraocular pressure without signs of glaucoma damage to the optic nerve or visual field. The key is that the pressure is higher than normal, but there is no cupping of the optic disc, no thinning of the neuroretinal rim, no retinal nerve fiber layer loss, and no reproducible visual field defect. So the scenario with elevated IOP but no definitive glaucoma damage fits best. If there were documented glaucoma damage, it would be glaucoma rather than ocular hypertension. If the IOP were normal, or if there were high risk factors with normal pressure, that would not meet the definition of ocular hypertension. Ocular hypertension is a risk state that requires monitoring because some people may develop glaucoma over time, while others may never progress.