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In the name of god

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Target IOP S.M.Shahshahan M.D Feb 2010

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History In the early 1960 Chandler has observed the need for varying target IOPs according to the severity of glaucoma.

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Definition (AAO) Target IOP The upper limit of the range of measured IOP adequate to stop progressive pressure induced injury of the optic nerve.

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Definition (The european glaucoma society) Estimate of the mean IOP obtained with treatment that is expected to prevent further glaucomatous damage.

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IOP Is the only known risk factor which can be modified to arrest or slow progressive glaucomatous optic neuropathy.

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Most important factors for target IOP level 1-Severity of glaucomatous damage to optic nerve head 2-Age 3-Baseline IOP 4-Central corneal thickness 5-Associated ocular disease 6-Risk of treatment 7-Systemic morbidity

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1-Severity of glaucomatous damage to optic nerve head The optic nerve head evaluation(C/D ratio) Extent of visual field loss -Visual field loss encroaching on fixation

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2-Age There is gradual,steady decrease in the number of the nerve fibers ( 4% - 5% per decade after the age of 50 ). Elderly patients with early glaucoma may not need to be treated aggressively unless central fixation is threated. (Lower target IOPs in young patients) Life expectancy

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3-Baseline IOP It is essential to get an accurate estimate of the baseline IOP(Mean of 4-6 IOP at different times). The risk of progression increases significantly with increasing IOP.

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4-Central corneal thickness In the OHTS : the risk for developing glaucoma doubles for every 40 microns of CCT thining. CCT is an indipendent predictor of glaucoma. The effect of CCT on IOP measurement is probably not important except in the eyes with extremely thick or thin corneas.

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5-Associated ocular diseases: Pseudoexfoliation has been associated with an increased risk of conversion from OHT to POG.

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6-Risk of treatment There is a significant association between cardiovascular mortality and glaucoma particularly in patients also treated with topical Timolol ( The blue mountain eye study) In older individual or early glaucoma,it may be acceptable to leave the IOP higher than the target,rather than prescribe topical B-blockers or prefer glaucoma surgery.

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7-Systemic morbidity Studies are ongoing looking into non-IOP factors (such as hypertension and D.M) contributing to the disease.

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