Ocular Hypertension Treatment & Management

Updated: Mar 16, 2020
  • Author: Anne Chang-Godinich, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

Approach Considerations

A clinical management strategy that targets a 20% reduction in IOP in people with ocular hypertension has been shown to delay or prevent the onset of glaucoma. [54]

Considering the high average monthly cost of glaucoma medication, along with the possible risks of adverse effects or toxic reactions from drugs, inconvenience of use, and sometimes uncertainty of the overall efficacy of prophylactic therapy, there is strong reason not to treat indiscriminately. [55, 56, 57] The OHTS suggests that treatment of patients with IOP higher than 24 mm Hg among those who have a greater than 2% annual risk of developing glaucoma (see the Prognosis section) is cost-effective. [58]

Individualization of therapy is the key; an ideal pressure in one patient may cause glaucomatous damage in another person. Periodically reevaluating the target IOP and performing a review of IOP trends and optic nerve anatomy and function via visual-field testing is necessary to determine whether the patient is consistently maintaining his or her ideal pressure.

Medical care

When risk of progression to POAG is present, treatment with IOP-lowering medications is indicated. See Medication.

Surgical care

Generally, if control cannot be achieved with medications, reconsider the diagnosis of ocular hypertension as that of early POAG. Laser and surgical therapy are not viewed as mainstay treatments for ocular hypertension.

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Consultations

Referral to a subspecialist fellowship trained in glaucoma and/or neuro-ophthalmology should be considered if there is continued inadequate pressure control, loss of visual acuity, visual-field constriction, optic nerve pallor or cupping, associated systemic conditions, or atypical findings.

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Follow Up

Depending on the assessed annual risk of developing glaucoma and level of IOP control, patients may need to be seen at intervals ranging from yearly to every 2 months, or even more frequently if there is a marked lack of IOP control. [28]

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Long-Term Monitoring

Patients should be observed regularly over their lifetime because some are at increased risk for the development of glaucomatous damage. If treated with medications, the potential for adverse effects or toxic reactions from topical medications exists (see Medication).

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