The ideal drug for treatment of ocular hypertension should effectively lower intraocular pressure, have no side effects, and be inexpensive with once-a-day dosing; however, no medicine possesses all of the above. When choosing a medicine for you, your ophthalmologist prioritizes these qualities based on your specific needs.
Medications, usually in the form of medicated eyedrops, are prescribed to help lower increased intraocular pressure. Sometimes, more than 1 medicine is needed. See Understanding Glaucoma Medications.
Initially, your ophthalmologist might have you use the eyedrops in only one eye to see how effective the drug is in lowering the pressure inside your eye. If it is effective, then your doctor will most likely have you use the eyedrops in both eyes. See How to Instill Your Eyedrops.
Once a medicine is prescribed, you have regular follow-up visits with your ophthalmologist. The first follow-up visit is usually 3-4 weeks after beginning the medicine. Your pressures are checked to ensure the drug is helping to lower your intraocular pressure. If the drug is working and is not causing any side effects, then it is continued and you are reevaluated 2-4 months later. If the drug is not helping to lower your intraocular pressure, then you will stop taking that drug and a new drug will be prescribed.
Your ophthalmologist may schedule your follow-up visits in accordance with the particular drug you are taking, because some medicines (eg, latanoprost [Xalatan], travoprost [Travatan], bimatoprost [Lumigan]) may take 6-8 weeks to be fully effective.
During these follow-up visits, your ophthalmologist also observes you for any allergic reactions to the drug. If you are experiencing any side effects or symptoms while on the drug, be sure to tell your ophthalmologist.
Generally, if the pressure inside the eye cannot be lowered with 1-2 medicines, you might have early primary open-angle glaucoma instead of ocular hypertension. In this case, your ophthalmologist will discuss the appropriate next steps in your treatment plan.
Laser and surgical therapy are not generally used to treat ocular hypertension because the risks associated with these therapies are higher than the actual risk of developing glaucomatous damage from ocular hypertension. However, if you cannot tolerate your eye medications, laser surgery could be an option, and you should discuss this therapy with your ophthalmologist.
Next Steps Follow-up
Depending on the amount of optic nerve damage and the level of intraocular pressure control, people with ocular hypertension may need to be seen from every 2 months to yearly, even sooner if the pressures are not being adequately controlled.
Glaucoma should still be a concern in people who have elevated intraocular pressure with normal-looking optic nerves and normal visual field testing results or in people who have normal intraocular pressure with suspicious-looking optic nerves and visual field testing results. These people should be observed closely because they are at an increased risk for glaucoma.