Target Intraocular Pressure
Î When deciding to treat a glaucoma suspect patient, it is important to
remember that the goal of treatment is to maintain the IOP in a range
at which visual field loss is unlikely to significantly affect a patient's
health-related quality of life over his or her lifetime. (II+, M, D)
Note: The estimated upper limit of this range is considered the "target pressure."
Target pressure can vary among these patients, and in the same patient it may need
adjustment during the clinical course. In any patient, target pressure is an estimate
and a means toward the ultimate goal of protecting the patient's vision.
Î It is reasonable to begin by choosing a target pressure of 20% lower
than the mean of several baseline IOP measurements based on criteria
from OHTS. (I+, M, D)
Note: Current IOP and its relationship to target IOP should be evaluated at each
visit and individualized for each patient.
Î A good way to assess IOP-lowering response is to compare the effect
in one eye with multiple baseline measurements in the same eye, but
the number of necessary baseline measurements will vary among
patients. (II+, M, D)
Î If a drug fails to reduce IOP sufficiently, then either switching to an
alternative medication as monotherapy or adding additional medication
is appropriate until the desired IOP level is attained. (III, G, S)
Î The ophthalmologist should assess the patient for local ocular and
systemic side effects and toxicity, including interactions with other
medications and potential life-threatening adverse reactions. (G, S)
Î At each examination, medication dosage and frequency of use should
be recorded. (G, S)
Î Adherence to the therapeutic regimen and recommendations for
therapeutic alternatives, such as laser trabeculoplasty, or diagnostic
procedures should be discussed. (G, S)
Laser Trabeculoplasty
Î Laser trabeculoplasty should be considered when nonadherence,
convenience, side effects, or risks of medication are factors. (G, S)
Î The ophthalmologist should consider these issues in choosing a
regimen that works well to lower IOP with the least possible side
effects. (G, S)
Î The diagnosis, number and severity of risk factors, prognosis and
management plan, and likelihood of long-term therapy should be
discussed with the patient. (G, S)
Management
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