Abstract
How to decide which patient should receive treatment to prevent conversion to glaucoma? Ocular hypertension is the only treatable risk factor for glaucoma, yet not all patients with hypertension develop glaucoma, and not all glaucoma patients have ocular hypertension. Deciding when and how to start treatment can be challenging, particularly in patients without other risk factors. When facing this dilemma one should ponder: the patient’s risk tolerance/avoidance, the prospect of long-term topical treatment including adverse effects, the psychological and economical burden of a pre-disease state and its treatment, treatment compliance, and the possibility of over-treating. New tools such as AI-guided image analysis, improved testing algorithms, and novel minimally invasive treatments may help control and weigh this risk factor more conveniently, avoiding over-treatment but preventing glaucoma-related blindness.