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T. M. Wright, S. S. Stinnett, P. P. Lee; Documentation of Target Intraocular Pressure as a Quality of Care Measurement in an Academic Group Practice. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1266.
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To measure documentation of target intraocular pressure (IOP) in patients with primary open glaucoma (POAG), to investigate the ranges of set target IOP for varying severities of glaucoma, and to investigate the impact of documentation of target IOP on disease management.
We reviewed 67 cases (132 eyes) of POAG seen since 2004 to evaluate glaucoma severity, treatment, and documentation of target IOP by comprehensive ophthalmologists and glaucoma specialists. Assessment of aspects of care emphasized by the American Academy of Ophthalmology Preferred Practice Patterns (PPP) for POAG included documentation of central corneal thickness (CCT), visual field testing intervals and results, maximum IOP, target pressure, optical coherence tomography results, and IOP at follow-up visits and adjustments in therapy. Severity stage of glaucoma was assigned based on PPP definitions.
Target IOP was documented in 64/132 eyes (48.5%). Target IOP was documented for 25/63 (39.7%) eyes followed by comprehensive ophthalmologists, 26/53 (49.1%) eyes followed by glaucoma specialists, and 13/16 (81.3%) eyes that were co-managed by both services (p=0.0109). Of the 64 eyes with documented target IOP, 32/64 (50%) were classified as mild severity, 20/64 (31.3%) were moderate severity, and 12/64 (18.8%) were severe cases (p=0.0546). Target IOP was significantly different between stages of severity for all patients, with an average target IOP of 17.1 +/- 2.7 mmHg for mild severity, and 13.9 +/- 2.5 mmHg for severe stages (p=0.0011). The average percent reduction from maximum IOP as defined by the target IOP set by glaucoma specialists was 27.0% in mild cases and 53.2% in severe cases. For patients with mild glaucoma, the mean IOP after documentation of target IOP was 3.77 mmHg lower than the mean pre-documentation IOP (p=0.0002); for patients with severe glaucoma, the mean post-documentation IOP was 4.83 mmHg lower than mean pre-documentation IOP (p=0.0313).
The documentation rate of target IOP in this series was almost 50%. Target IOP was more frequently documented by glaucoma specialists as compared to comprehensive ophthalmologists. Both physician groups were more aggressive with IOP lowering in more severe cases. Achieved pressures were significantly lower after the documentation of target IOP.
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