Target IOP an essential element in glaucoma management

A target IOP should be set whenever the diagnosis of ocular hypertension or glaucoma is first made, and it should be re-evaluated at each follow-up visit as part of the assessment of the efficacy of treatment for stopping visual field progression and protecting the optic nerve, said Curt Hartleben, MD, at the World Congress of Ophthalmology.

Dr. Hartleben told attendees Monday that there are a number of factors that should be taken into account in determining the target IOP. Disease and disease severity are two primary considerations, and in that regard, there is some guidance provided by the results of the large randomized, clinical trials. For ocular hypertensives, the target might be based on achieving a 20% to 35% reduction from baseline IOP, while a more aggressive goal of a 30% to 35% reduction or to at least between 15 and 18 mm Hg should be aimed for in individuals with mild initial primary open angle glaucoma (POAG).

In eyes with advanced POAG or normal tension glaucoma, available evidence suggests an even lower IOP range of 11 to 13 mm Hg should be the goal, while in eyes with normal tension glaucoma having very excavated optic nerves, a target of 8 to 10 mm Hg is recommended.

"Remember, glaucoma is an optic nerve neuropathy and the target should be lowered for eyes with more damage," said Dr. Hartleben, chief of glaucoma, Institute of Ophthalmology, Mexico City, Mexico.

Age of onset is another feature to take into account based on its relationship with life expectancy. In that regard, Dr. Hartleben noted older patients may need less of an aggressive IOP target than their younger counterparts. Finally, quality of life should never be overlooked.

"The more medications the patient is on, the greater the reduction in quality of life and compliance," he said.