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they develop the optic neuropathy because of the elevated IOP. For clinicians, the most important fact is that by controlling the pressure, we currently have the best way of preventing the blindness. Ref: http://www.ophthalmologytimes.com
According to the AGIS study, reducing IOP in glaucoma patients limits disease progression and slows visual field loss.
According to the EMGT study, for every 1 mm drop in IOP, a 10% reduction in risk of glaucomatous progression was observed.
Thus lowering IOP to an appropriate level reduces the risk of further visual loss It is now agreed that using a number (e.g. < 21 mmHg) is obsolete, because it does not take into account the individual variability for each patient
Ref:1. Surveys of Ophthalmology 2003; 48 (suppl 1): 53-57 2. Bull. Soc. Belge Ophthalmol 1999; 274: 61-65
A target pressure should be set as a goal of long term therapy: it should be chosen on an individual basis, weighing potential benefits and risks of treatment for each patient.
TARGET IOP
The goal of the clinician while treating patients with glaucoma should be to lower the intraocular pressure to a level that is safe for that particular eye.
Target IOP may be defined as a pressure, rather a range of intraocular pressure levels within which the progression of glaucoma and visual field loss will be delayed or halted
IOP level at which optic nerve damage occurred Extent and rate of progression of glaucomatous damage, if known Presence of other risk factors Patients age Expected life span Medical history
Ref: Surveys of Ophthalmology 2003; 48 (suppl 1); 53-57
Target IOP = Maximum IOP Maximum IOP% - Z Z is an optic nerve damage severity factor. Z Optic Nerve damage 0 Normal disc and Normal visual field 1 Abnormal Disc and Normal visual field 2 Visual field loss not threatening fixation 3 Visual field loss threatening or involving fixation
Ref: Bull Soc. Belge Ophthalmol 274, 61-65, 1999
For e.g.: An eye with a maximum IOP of 30 mmHg, optic nerve damage and visual field loss not threatening fixation would have a target set at 19 mmHg (30-30%-2)
Recommended to record and highlight the target pressure in the chart of a patient Draw an IOP curve for each glaucomatous patient and to highlight the target pressure on the curve
Ref: Bull. Soc. Belge Ophthalmol 274; 61-65, 1999
Target pressures should be reevaluated periodically. This is because a target IOP that is appropriate when you first see a patient may not be safe pressure 10 years later when he or she may have developed systemic hypertension, diabetes, or some other condition that may affect the patients susceptibility to glaucomatous progression
Ref: Surv. Of Ophthalmology 2003; 48 (suppl 1): 53-57
Youre not going to have one target pressure thats appropriate for every patient. It is a dynamic process and you always have to be alert and open to modification.
L. Jay Katz, Professor of Ophthalmology Jefferson Medical College
Patients should be followed closely over time and their target pressures should be adjusted, depending upon how the patient is doing. If the patient progresses, the target pressure should be lowered. If the patient does very well, the target pressure should be lowered. If the patient does very well, the target might be raised.
Stevens Simmons, Associate Clinical Professor, Albany Medical College
Target IOP should be individualized as per patient and should be a flexible ever changing variable varying with the progression of the disease The concept of a target IOP should be a part of the standard of care for physicians who treat glaucoma patients The methods used to maintain the target pressure should be sustainable over the long term with minimal adverse effects