Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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The Concept of Target Pressure: The Lower the Better?

Traverso C. E.
Universita di Genova, Department of Ophthalmology, Genova

Although normal IOP is defined for populations, the IOP level that is safe in each individual both in health and disease defies statistical definitions. Treating glaucoma makes sense only if it preserves the well being, the health status and quality of life of patients.
Definition of target IOP:
Target IOP is the mean IOP obtained with treatment that prevents further glaucomatous damage in the eye of the individual under consideration. The main problems of Target IOP assessment are that it must be individualised to the patient and to each eye, it should be an accurate estimate and it needs to be determined in advance. Target IOP is often treated as a single figure, but it is to be considered as a range of intraocular pressures.
Data which can be use in target IOP assessment include:
1) Stage of glaucoma damage The greater the pre-existing glaucoma damage, the lower the target IOP should be. It is clinically relevant that in eyes with severe pre-existing damage, any further damage may be functionally important. IOP level before treatment
2) The higher the IOP at which damage occurred, the higher the Target IOP, and viceversa. Minimum, maximum and the size of fluctuations of IOP should all be considered. When in doubt, a diurnal curve is indicated.
3) Rate of progression of glaucomatous damage If not progressing, treatment is questionable. The faster the progression rate, the lower the Target IOP and viceversa With advanced disease, progression e

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