BLOG: The IOP debate — what is the number we are actually looking for?

Elevated IOP, which can lead to glaucoma and vision loss, is always a cause for concern. Lowering IOP continues to be the only known treatment for glaucoma, and it can be accomplished in a variety of ways, including topical medications and laser treatments. However, the “normal” pressure range and the goal that should be achieved when treating to lower pressure are still up for debate.

A “normal” pressure is typically seen as ranging from approximately 12 mm Hg to 22 mm Hg, although an optimal range would be on the lower end, somewhere around 12 mm Hg to 14 mm Hg. Patients differ, however. Some have pressures that are naturally higher, and dropping it too low could be detrimental. Therefore, determining a goal IOP is something that should be formulated after a great deal of thought, research, as well as examination of the patient and discussion of their specific needs.

When setting a therapy goal, aiming for a decrease of pressure in terms of percentage, rather than a fixed number, might be more constructive. What I generally look for is a stabilization of the patient’s testing. I want to pay attention to their optic nerve OCT and visual field tests and whether or not their pressure has stabilized or is continuing to increase.

The bottom line is that there is no magical number we can aim for that will suit everyone’s needs. Each patient is unique, and the goal IOP for each will likewise differ. We can, however, strive to ensure each individual patient is achieving enough of a percentage decrease that their anatomy is stabilized, which would establish an optimum range for that patient.

Disclosure: Toyos reports she is a speaker and consultant for Valeant and Sun; conducts research for Lumenis, Magellan and Kala; is a speaker and consultant and does research for Shire, Mallinckrodt and MixtoLasering; is a consultant and does research for DigiSight; does research for Novaliq; and is a consultant for Iridex.