Indications for medical treatment of ocular hypertension and the initial use of pilocarpine.

Abstract Ocular hypertension is defined. The decision to initiate treatment depends on the estimate of the benefit to injury ratio with a given treatment and the risk without treatment. Factors that determine our perception of the former are discussed. The key to the latter is the identification and evaluation of the ocular and systemic risk factors for the development of glaucomatous visual field loss. Discussion of these risk factors in the author's clinical practice is presented; overall, approximately 5% of his patients with ocular hypertension are treated. A review of his four-and-a-half year study on uniocular pilocarpine treatment in 59 ocular hypertensive patients is presented. The results suggest that one should be conservative in prescribing pilocarpine.