Ocular Hypertension Management
Not every elevated eye pressure reading needs treatment — management here is a calculated, individualized decision based on your personal risk of developing true glaucoma.
A Risk-Based Decision, Not an Automatic Treatment
Ocular hypertension — elevated eye pressure with a healthy optic nerve and normal visual field — is a risk state, not a disease. The landmark Ocular Hypertension Treatment Study (OHTS) found that treatment roughly halved the risk of progressing to glaucoma in higher-risk patients, while many lower-risk patients did well with observation alone.1 Management here starts with calculating your individual risk, not with automatically starting treatment.
Calculating Your Risk
We combine your eye pressure, corneal thickness (a factor shown by OHTS to independently predict risk), optic nerve cup-to-disc ratio, age, and other factors using a validated risk model to estimate your five-year risk of developing glaucoma, then discuss that risk with you directly before deciding on a plan.
Option 1: Observation
For patients with lower calculated risk, periodic monitoring with OCT imaging and visual field testing, typically every 6–12 months, is a reasonable and well-supported approach that avoids unnecessary treatment.
Option 2: Eye Drops or SLT Laser
For higher-risk patients, or those who prefer a more proactive approach, a once-daily prostaglandin eye drop or SLT laser are both effective, low-risk first choices — the same options used as first-line treatment in open-angle glaucoma. See our Eye Drops & Oral Medications and SLT Laser pages.
Learn more about the underlying condition, including the specific risk factors OHTS identified, on our Ocular Hypertension page.
References
- Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120(6):701-713.
Frequently Asked Questions
Will I definitely need treatment?
Not necessarily. Depending on your calculated risk, careful monitoring alone is a legitimate, evidence-based option for many patients with ocular hypertension.
What determines my risk?
Your eye pressure level, corneal thickness, optic nerve appearance, age, and family history are combined using a validated risk model derived from the OHTS trial to estimate your five-year risk of developing glaucoma.
If I do need treatment, what's used first?
A once-daily prostaglandin eye drop or SLT laser are both reasonable first choices, the same as in open-angle glaucoma.
How often will I be monitored?
Typically every 6–12 months with OCT imaging and visual field testing, more or less often depending on your individual risk level.
See a glaucoma specialist. Dr. Robert Gunzenhauser is Harvard-educated and UCLA fellowship-trained in glaucoma, providing expert diagnosis and treatment for Ocular Hypertension Management at Inland Glaucoma Center in Upland, CA.