Should patients with ocular hypertension be treated to prevent glaucomatous visual field loss? Three considerations suggest that for most patients the answer is no. First, the average risk of visual field loss in untreated ocular hypertension is small. Population surveys and prospective studies indicate that no more than about one of every nine persons with intraocular pressures higher than 20 mm Hg will develop a visual field defect. Secondly, treatment of ocular hypertension to lower intraocular pressure is unproven efficacy in preventing visual field defects. Thirdly, adverse reactions to glaucoma therapy occur frequently and are sometimes serious. Although pressure reduction may be indicated for some patients who possess certain risk factors which make them especially susceptible to glaucomatous damage, for most patients "no treatment" is the best management. Untreated patients must be observed carefully with periodic visual field and optic disc examinations.
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