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Better understanding of IOP fluctuations helps refine clinical choices
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SAN DIEGO — A growing body of knowledge about how IOP changes in different patients and situations has led to important insights as to why certain patients do better than others with either medical therapy, laser therapy or surgical intervention, according to a speaker here.
Adam C. Reynolds, MD, discussed issues and trends in the understanding of IOP during the American Society of Cataract and Refractive Surgery's Glaucoma Day.
"There has been a long tradition of assumption that higher variations of IOP lead to more risk of progression," Dr. Reynolds said. "There are more data coming out now and more interesting twists and turns."
The manner in which IOP fluctuates and how it relates to other factors, such as position changes and blood pressure, is now better understood. This understanding holds "significant implications for predicting progression risk and how we treat," Dr. Reynolds said.
For example, long-term IOP fluctuations have yielded a better understanding of whether these changes are related to compliance issues or the disease itself. Research has supported an earlier, more aggressive approach with patients who experience more fluctuation.
In addition, the patient's entire medical situation must be considered when determining the best treatment option, now that the relationship between IOP and blood pressure is clearer. Diurnal fluctuations have also grown in importance.
"What is happening with the patient's pressure at night when we're not monitoring them is probably more important than we thought," Dr. Reynolds said.
Overall, clinicians need to look at recent IOP-related research to refine their medical approaches. They need to look at which drugs, combination of drugs, or surgical interventions will produce a lasting reduction in pressure and suppression of IOP fluctuation.