Management of Ocular Hypertension

CASE REPORT A 73-year-old Hispanic woman with Type II diabetes mellitus for the past 3 years is referred for management of ocular hypertension. Her family history is unremarkable. Slitlamp biomicroscopy reveals no apparent secondary cause for her elevated intraocular pressure (IOP) and both angles are widely open with mild, uniform, trabecular pigmentation. Cup–disc ratios are 0.6 OU, with pink, healthy neural rims without evidence of thinning, notch, nerve fiber layer defect, or localized pallor. Achromatic automated perimetry is unremarkable, and short-wavelength perimetry is unreliable. IOPs range from 23 to 28 mm Hg. Corneal thicknesses are 558 and 560 μm, in the right and left eyes, respectively. 1. Which patients with ocular hypertension should be treated? 2. Should one correct IOP for corneal thickness and if so, how should this be done? 3. How should IOP be measured in eyes with irregular corneal surfaces or following keratorefractive surgery?