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Multiple measurements needed to determine efficacy of IOP-lowering therapy
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SAN FRANCISCO — Because IOP measurements are a “moving target,” glaucoma specialists have yet to agree on the best way of assessing the therapeutic effect of ocular hypotensive therapy, according to a presenter here.
“We can’t make decisions based on single pressure measurements,” Anthony D. Realini, MD, MPH, said at the American Glaucoma Society annual meeting. Rather, several pre-treatment measurements and several on-treatment measurements are needed in order to decipher meaningful trends in IOP behavior.
Anthony D. Realini
This gold standard of trend analysis, however, is still not good enough, and a more efficient method is needed, Realini said, in particular for establishing optimal frequency and timing of IOP measurements necessary to characterize an individual’s therapeutic response to IOP-lowering therapy.
In the absence of a better method, Realini recommended the following general principles: Take two to three measurements on different days before starting therapy, and treat both eyes.
“Monocular treatment doesn’t determine whether or not the drug worked; it just deprives the other eye of treatment for some period of time,” Realini said, adding that two or three on-treatment measurements should be obtained before a decision is rendered whether treatment worked.
“The take-home point is this,” he said, “Glaucoma is a slowly progressive chronic disease, and very few of our patients need urgent IOP reduction. Once you select your agent of choice and apply it, give it more than one office visit. Give it more than one chance to show you that it worked.”
Disclosure: Realini is a consultant for Alcon, is on the speakers bureau for Lumenis, and has received research equipment from Lumenis and Sensimed.