Wills Eye Conference

Wills Eye Conference

March 11, 2014
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Higher peak, final IOP portend progression in average-pressure glaucoma

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PHILADELPHIA — Average-pressure glaucoma requires keen surveillance and monitoring of IOP, central corneal thickness and disc hemorrhage, according to a study presented here.

“Average-pressure glaucoma is a chronic open-angle glaucoma with progressive optic nerve damage despite the intraocular pressure always remaining below 21 mm Hg,” Sarah Driscoll Kuchar, MD, said at the Wills Eye Annual Conference. “Tighter intraocular pressure control in patients with average-pressure glaucoma potentially allows them to ward off progression and remain stable for longer.”

Sarah Driscoll Kuchar

The retrospective study included 49 eyes with average-pressure glaucoma followed for an average of 9 years. Patients underwent evaluation of optic nerve status, visual fields and IOP.

Glaucoma progressed in 25 eyes and remained stable in 24 eyes. Eyes with progressive glaucoma had higher peak IOP. Thinner central corneal thickness and disc hemorrhage also correlated with progression.

“Based on our definitions of progression, it stands to reason that a higher final cup-to-disc ratio and a greater change in cup-to-disc ratio would be associated with progression, but the baseline cup-to-disc ratio was not, which suggests that the baseline optic nerve assessment may be a poor predictive marker for progression or stability,” Kuchar said.

Higher IOP and final IOP were significantly associated with worsening.

“This suggests that if you have a patient with a rising trend in intraocular pressure, this should serve as a serious flag for the treating physician that this patient is at risk for progression,” Kuchar said.

Disclosure: Kuchar has no relevant financial disclosures.