Previously, Chandler and Armaly argued that only a very small percentage of patients with hypertension develop glaucomatous visual impairment, after which there has been controversy regarding the treatment or non-treatment of hypertension. Those who hold a conservative view advocate follow-up of patients with hypertension without treatment unless IOP reaches 30 mmHg or more or there is suspected structural and functional damage to the optic nerve; others believe that loss of retinal nerve fibers may have occurred in 20% to 50% of patients before progression is detected by conventional visual field examination and that nerve fiber damage is a positive feedback process; furthermore, the If the patient is not treated, it is likely to cause the patient to lose visits, which is likely to have serious consequences. The treatment of glaucoma should focus on long-term outcomes, and the goal of treatment is to preserve visual function. IOP is the only risk factor that is clearly causally related to glaucomatous visual impairment and the only risk factor that can be controlled and intervened. Several clinical trials have demonstrated that approximately 85-95% of patients with advanced POAG and 80% of NTG patients have IOP-dependent visual impairment, and that aggressive reduction of IOP can control the progression of glaucoma disease. The Advanced Glaucoma Intervention Study (AGIS) showed no progression of visual field damage in patients with a mean IOP of 12 mmHg and consistently fluctuating IOP below 18 mmHg over an 8-year follow-up period. The Collaborative Normal-Tension Glaucoma Study Group showed that a 30% reduction in IOP, i.e., a reduction in mean IOP from 16 mmHg to 11 mmHg, reduced the risk of glaucoma damage from 60% to 20% over 5 years. Although there is an overlap in IOP values between those with and without progression, and only 35% of glaucoma is due to elevated IOP, lower IOP levels do help reduce damage to retinal nerve fibers or visual function. The results of other related studies are also consistent with these findings, while a quantitative relationship between IOP and glaucoma incidence in the population was found, with a 3 mmHg increase in IOP doubling the incidence of glaucoma, and a very low incidence of glaucoma when IOP levels were above and below 10 mmHg. However, it is worth noting that the results of the OHTS I and OHTS II studies after 13 years of follow-up showed that early treatment significantly reduced the incidence of POAG in patients with several risk factors, including elevated IOP, thin corneal thickness, and large cup-to-disc ratio, but that early treatment had no effect on those at low risk. The results of the OHTS phase I study showed that the incidence of POAG was 50% lower in patients with hypertension treated with IOP-lowering medications than in patients randomized to the observation-only group. Among the patients in the treatment group, their IOP dropped to 25 mmHg or lower and reached at least 20% of the baseline after treatment. After 5 years of follow-up, the incidence of POAG was only 4.4% in the treatment group, compared to 9.5% in the observation group. However, this still means that drug therapy may not be necessary for more than 90% of patients. OHTS therefore initiated a second phase of the study to better define what kind of patients with hypertension should receive IOP-lowering therapy. The second phase of the study was conducted from June 1, 2002 to February 9, 2009, with patients in the previous observation group receiving IOP-lowering therapy and patients in the previous treatment group continuing medication. An early treatment group versus a delayed treatment group was established by this method. After a total of 13 years of follow-up, the difference in the incidence of POAG between the two groups was statistically significant (p=0.009), but significantly lower than the difference between the two groups in the first phase of the study. The cumulative incidence of POAG at the 13-year follow-up was 22% in the delayed-treatment group compared with 16% in the early-treatment group. The difference in mean time to onset between the two groups was also statistically significant, with glaucoma patients in the delayed treatment group having a mean of 8.7 years to onset compared with 6.0 years in the early treatment group (p ≤ 0.001). In addition, 6% of patients in the delayed treatment group developed disease in both eyes, compared with 4% in the early treatment group. Another finding of the study was that early treatment reduced the incidence of glaucoma in the mostly very high-risk group, but did not provide any benefit to the low-risk group, according to the OHTS/EGFS predictive model of POAG onset, which is based on five key factors influencing glaucoma progression recognized by the OHTS and European Glaucoma Prevention Study, which The analysis of the 13-year follow-up showed that the incidence of glaucoma in the low-risk group was 7% in the early treatment group and 8% in the delayed treatment group. In contrast, the incidence of glaucoma in the high-risk group was only 28% in the early treatment group, compared with 40% in the delayed treatment group. In addition, patients of African descent may be at higher risk of developing glaucoma. In the first phase of the OHTS study, the prevalence rate among African-Americans was 12.7% in the observation group and 6.9% in the treatment group, compared with 10.2% and 3.6%, respectively, among non-Africans. After 13 years of follow-up, the prevalence of glaucoma in African Americans was 29% in the delayed-treatment group and 26% in the early-treatment group. In contrast, among other ethnic groups, the incidence was 19.5 percent in the delayed-treatment group compared with 13 percent in the early-treatment group. However, the OHTS investigators found that after correction for central corneal thickness to cup-to-disc ratio, ethnicity was not a predictor of POAG onset. However, the OHTS group suggested that given that the prevalence of glaucoma is four times higher in people of African descent than in people of European descent, it is possible that ethnicity could be found to be a specific factor in a larger sample. Thus, it is clear that the specific treatment strategy for hyperopia needs to be individualized, and when the diagnosis is unclear or there are no definite risk factors for glaucoma, pharmacological treatment is supposed to be cautious to prevent giving patients unreasonable and unnecessary transitional treatment, otherwise, it will not only increase the economic and mental burden of patients and their families, but may also cause medically induced damage to patients. In conclusion, it is important to first clearly determine whether high IOP is beneficial before considering whether therapeutic treatment brings benefits, and not to blindly over-treat the patient. At the same time, it is important to emphasize the importance of regular follow-up to observe whether there are progressive changes or damage, so that proper early diagnosis and treatment can be achieved in a timely manner once changes or damage occur.