Abstract
Purpose :
Clinical guidelines for glaucoma management recommend setting a target intraocular pressure (IOP) and using medical or surgical interventions to achieve this target. However, there is limited data on practice patterns regarding the longitudinal management of target IOP. This study characterized how glaucoma specialists utilized target IOP in care delivery decision-making at one tertiary academic center across a 10 year period.
Methods :
We conducted a retrospective chart review of all glaucoma patients who were followed by a University of Iowa Hospital and Clinics glaucoma specialist for at least 10 years. Patients with congenital, juvenile, and secondary glaucoma as well as anatomic narrow angles were excluded. The variables assessed included type of glaucoma, initial and most recent target IOP, the frequency of target IOP change, rationale for target change, and actions taken to reach target IOP. Differences among these variables across types of glaucoma and primary clinicians were assessed using ANOVA, student’s t-test, and chi square analysis.
Results :
503 eyes met inclusion criteria. These included 229 eyes with primary open angle glaucoma (POAG), 171 with normal tension glaucoma, 73 with pigmentary glaucoma (PG), and 30 with pseudoexfoliative glaucoma (PEXG). The average initial target IOP was 15.7±3.9 and the average final target IOP was 14.6±3.7 with an average total magnitude of change of -1.0±2.4. The target IOP was changed an average of 0.6±0.8 times with an average magnitude of -1.8±2.7 mmHg per change. Target IOP was changed significantly fewer times for PG compared to POAG (p-value < 0.05) and PG compared to PEXG (p-value < 0.05). There were no significant differences between glaucoma subtypes regarding magnitude of individual changes and total magnitude of IOP target change. The most common rationales for change were worsening Humphrey visual field followed by provider change, with no significant differences between glaucoma subtypes. The three most frequent actions taken in response to a target IOP change were observation, medication escalation and surgery, respectively.
Conclusions :
Patients with PG had their IOP target changed significantly fewer times than patients with POAG and PEXG. The glaucoma subtypes did not significantly vary in total magnitude of IOP change, magnitude per individual change, and rationale for change.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.