New research from the John A. Moran Eye Center shows that while our understanding of glaucoma has advanced, ophthalmologists are still relying on a long-standing threshold number for eye pressure that has influenced care for decades.
Published in JAMA Ophthalmology, the study, “Influence of Intraocular Pressure on Clinical Decision-Making in Glaucoma Management,” details an analysis of more than 1.8 million glaucoma clinic visits across seven U.S. academic eye centers. Researchers found clinicians were significantly more likely to start or intensify glaucoma treatment when a patient’s intraocular pressure reached 22 millimeters of mercury (mm Hg).
While the threshold has long been considered the upper end of “normal” eye pressure, glaucoma can develop or progress at lower pressures, and some people with higher pressures never develop the disease. Ophthalmologists also consider optic nerve health, visual field testing, advanced imaging methods, family history, and other risk factors when deciding when to begin or adjust treatment.
“The future of glaucoma care is moving beyond fixed pressure cutoffs toward more individualized, risk-based treatment decisions that better reflect our understanding of the disease,” said Ashley Polski, MD, a Moran Eye Center ophthalmology fellow and lead author on the study.
Brian Stagg, MD, a glaucoma specialist and public health researcher with Moran’s Alan S. Crandall Center for Glaucoma Innovation, said the findings point to a need for improved decision-support tools in clinic that can help the field go beyond heavy reliance on a threshold number.
“Improved decision-support tools can aggregate patient data to help physicians better use continuous eye pressure and other factors to inform treatment, rather than relying on a single cutoff number,” he said.