Are you certain it matters?...
In our management of glaucoma, we need to first and always prioritize progression vs purely depending on intraocular pressure (IOP) to dictate changing or adding to our usual topical approach.
While it's true IOP remains the #1 modifiable risk factor in glaucoma, numerous clinical studies including the Early Manifest Glaucoma Trial and the Collaborative Normal-Tension Glaucoma Study, have shown individuals can still experience significant progressive visual field deficits despite hitting target IOPs. For example, in the UK Glaucoma Treatment Study (UKGTS), it was found 15% of patients who were treated with latanoprost continued to progress despite IOP reduction - this underscores the variability of individual responses to what we may think is proper treatment.
These findings remind us of the need to adopt a broader and more comprehensive approach - one which involves scrutinizing additional risk factors (ischemic, nutritional, metabolic, and others) - then adopting more relevant management strategies vs relying solely on IOP targets.
It matters to truly understand and consider additional pathophysiologic mechanisms in terms of glaucomatous optic neuropathy. We will then be in a better position to improve outcomes via personalized interventions - ultimately leading to preservation of vision.
- JRM
Go to the article in Ophthalmology Glaucoma HERE.
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