What is good pressure control

The diagnosis of glaucoma is based on morphological and functional parameters and not on IOP level, whereas treatment is centered on adequate IOP control. Good IOP control implies that IOP is brought down to values at which no further damage occurs or to values that slow the rate of progression in order to maintain acceptable visual function during the patient’s lifetime. Target pressure for an individual patients will depend on the age of onset of the disease, the amount of damage at diagnosis, the level of untreated IOP, and the rate of progression. The longer the life expectancy, the more severe the functional damage, the lower the untreated IOP and the faster the rate of progression, the lower the target pressure should be and vice versa. An additional number of systemic (blood pressure, family history) and ocular risk factors (disc hemorrhages, PEX, myopia, corneal thickness) should be taken into account. Further follow up will indicate whether the initially chosen target pressure needs adjustment. The determination of target pressure is a dynamic process and from the available evidence it seems that there is a wide gap between preferred practice patterns and real life.