The facts are that people loss vision with glaucoma because of problems with optic neuropathy, but

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

RELATIONSHIP BETWEEN INTRAOCULAR PRESSURE AND VISUAL FIELD LOSS

The Australian Blue Mountain study found the odds

ratio of developing glaucoma was 4.7 times higher in patients with a screening IOP of greater than 21 mmHg than in patients with lower IOP.

Ref: Surveys of Ophthalmology 2003; 48 (Suppl 1): 53-57

RELATIONSHIP BETWEEN INTRAOCULAR PRESSURE AND VISUAL FIELD LOSS

According to the AGIS study, reducing IOP in glaucoma patients limits disease progression and slows visual field loss.

Ref: Surveys of Ophthalmology 2003; 48 (suppl 1): 53-57

RELATIONSHIP BETWEEN INTRAOCULAR PRESSURE AND 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.

Ref: Surveys of ophthalmology 2003; 48 (suppl 1): 53-57

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 21 mmHg) is obsolete, because it does not take into account the individual variability for each patient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

THE TARGET PRESSURE CONCEPT

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.

Ref: Surveys of Ophthalmology 2003; 48 (suppl 1): 53-57

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.

Ref: Surveys of Ophthalmology 2003; 48 (suppl 1): 53-57

TARGET IOP: DEFINITION

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

Ref: Surveys of Ophthalmology 2003; 48 (suppl 1): 53-57

SETTING TARGET IOP: FACTORS TO BE CONSIDERED

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

HOW TO CALCULATE TARGET IOP

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

HOW TO CALCULATE TARGET IOP

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)

Ref: Bull. Soc. Belge Ophthalmol 274, 61-65, 1999

AAO GUIDELINES: TARGET IOP

Glaucoma patients with mild damage (optic disc cupping but no visual field loss) Reduction of 20-30% from baseline Glaucoma patients with advance damage Reduction of 40% or more from baseline Normal pressure glaucoma Reduction of 30% from baseline Ocular hypertension Reduction of 20% from baseline
Surveys of Ophthalmology 2003; 48 (suppl 1): 53-57

AAO GUIDELINES: TARGET IOP

Open angle glaucoma with IOP in the mid to high 20s Target IOP range 14-18 mmHg Advanced Glaucoma Target IOP < 15 mmHg OHT whose IOP > 30 mmHg with no sign of optic nerve damage Target IOP < 20 mmHg

Ref: Surveys of Ophthalmology 2003; 48 (suppl 1); 53-57

HOW TO USE A TARGET IOP

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

HOW TO USE A TARGET IOP

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: SUMMARY AND RECOMMENDATIONS

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