Reposted from the John A. Moran Eye Center.
While our understanding of glaucoma has advanced, ophthalmologists are still relying on a long-standing threshold number for pressure inside the eye that has influenced care for decades, according to new research from the John A. Moran Eye Center at the University of Utah.
The study details an analysis of more than 1.8 million glaucoma clinic visits across seven U.S. academic eye centers, involving 94,000 unique patients with an average age of 69.5 years. Researchers found clinicians were significantly more likely to start or intensify glaucoma treatment when a patient’s intraocular pressure (IOP) reached or exceeded 22 millimeters of mercury (mm Hg).
Normal pressure falls between 10 and 21 mm Hg, according to the Glaucoma Research Foundation. Characterized by deteriorating vision as a result of damage to the optic nerve, glaucoma affects about 3 million Americans.
While the 22 mm threshold has long been considered the upper end of “normal” eye pressure, glaucoma can develop or progress at lower pressures, and some people with higher pressures never develop the disease. Ophthalmologists also consider optic nerve health, visual field testing, advanced imaging methods, family history and other risk factors when deciding when to begin or adjust treatment.
“The future of glaucoma care is moving beyond fixed pressure cutoffs toward more individualized, risk-based treatment decisions that better reflect our understanding of the disease,” said Ashley Polski, a Moran Eye Center ophthalmology fellow and lead author on the study.
The research was structured to explore whether IOP-lowering therapy was initiated or escalated within one week of the clinical encounter, laser treatment within four weeks, or glaucoma surgery within eight weeks. The team found the rate of IOP-lowering treatment increased with higher IOP levels, with the largest acceleration as IOPs exceeded 22 mm Hg.
These findings point to a need for improved decision-support tools in clinics that can help the field go beyond heavy reliance on a threshold number, according to co-author Brian Stagg, a glaucoma specialist and public health researcher with Moran’s Alan S. Crandall Center for Glaucoma Innovation.
“Improved decision-support tools can aggregate patient data to help physicians better use continuous eye pressure and other factors to inform treatment, rather than relying on a single cutoff number,” he said.
The study, “Influence of Intraocular Pressure on Clinical Decision-Making in Glaucoma Management,” was published online on Jan. 8 in JAMA Ophthalmology. Funding was provided by ARCS Foundation of Utah, the National Institutes of Health and Research to Prevent Blindness.
