THE TREATMENT of ocular hypertension has been problematical in the few decades since it was recognized by Chandler1 and Armaly2 that only a minority of such patients were destined to develop glaucomatous damage.
On the conservative side, many glaucoma specialists advocate following such patients without treatment unless the intraocular pressure (IOP) is quite high (eg, 30 mm Hg)3 or if it is difficult to be sure that the optic disc and visual field are normal. It is reasoned that observation alone allows timely intervention if damage begins, long before visual loss of consequence to the patient would occur, that in this way as many as 80% of patients with ocular hypertension avoid the cost and adverse effects of therapy, and that there is actually no convincing evidence that treatment delays or prevents damage.