## **Core Concept**
The patient presents with elevated intraocular pressure (IOP) and a family history of glaucoma, which are significant risk factors for developing glaucoma. The open angles on gonioscopy indicate that the patient likely has open-angle glaucoma, which is a common form of glaucoma characterized by the slow clogging of the drainage canals, resulting in increased eye pressure.

## **Why the Correct Answer is Right**
The management of open-angle glaucoma often starts with medical therapy to lower IOP. Prostaglandin analogs, beta-blockers, alpha agonists, and carbonic anhydrase inhibitors are common classes of medications used. The goal is to reduce IOP to prevent or slow the progression of glaucomatous damage, particularly visual field defects.

## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because, although not specified, typical first-line treatments might include prostaglandin analogs or beta-blockers, and the choice depends on various factors including side effect profiles and IOP reduction needed.
- **Option B:** Without specifics on what "B" entails, it's hard to directly refute, but generally, if it suggests not treating or delaying treatment, that would be incorrect given the elevated IOP and family history.
- **Option C:** Similarly, without specifics, if it suggests an inappropriate or insufficient treatment plan for glaucoma, it would be incorrect.
- **Option D:** Assuming "D" is the correct answer and implies initiating treatment to lower IOP given the elevated pressures and family history, then the other options would be incorrect based on standard glaucoma management protocols.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that the management of glaucoma aims to lower IOP to a target range that halts disease progression, often a 20% reduction from baseline or to 7-12 mmHg. Regular follow-up and monitoring for progression are crucial.

## **Correct Answer:** D. Start topical ocular hypotensive therapy.