Currents on target intraocular pressure and intraocular pressure fluctuations in glaucoma management.

Over the past decade, results from prospective, randomized, clinical trials have confirmed the value of reducing intraocular pressure (IOP) in patients with ocular hypertension or primary open-angle glaucoma and have outlined the need to consider a target IOP in an individual glaucomatous patient and not an arbitrary value of 21 mm Hg as classically believed. The target IOP corresponds to an estimation of the mean IOP obtained with treatment that is expected to prevent further glaucomatous damage. Target IOP is difficult to assess accurately in advance in every individual patient and eye. Moreover, no degree of IOP is proven to be safe for every patient. This paper will deal with the criteria that can be used to approach as closely as possible and periodically re-assess the range of the target IOP in an individual. Although IOP has been found to be more variable in glaucomatous than in healthy eyes, the potential role of diurnal IOP fluctuations in the development or progression of glaucomatous damage is still unclear. It has been strongly suggested in a recent past that abnormal 24-hour IOP fluctuation could be a significant risk factor for glaucomatous damage. There is still currently insufficient evidence to support that both 24-hour IOP fluctuation and IOP variation over periods longer than 24 hours are an independent and separate risk factor for glaucomatous damage. Until further confirmation on their exact role in glaucoma development and progression, the goal of detecting and reducing abnormal 24-hour IOP fluctuation is warranted in all newly diagnosed glaucomatous patients as well as in patients who continue to progress at lower pressures.