IOP Fluctuation and Visual Field Progression

July’s Ophthalmology

Using data from the Advanced Glaucoma Intervention Study, Caprioli and Coleman found that long-term fluctuation in IOP is associated with visual field progression in individuals with low mean IOP, but not in those with high mean IOP. The investigators only included eyes that had one surgical intervention. To calculate the mean IOP and IOP fluctuation in this study, the investigators used only IOPs from the surgical intervention up until the time of first evidence of a declining visual field.The study involved 301 eyes of 301 patients. Visual field progression was detected in 78 eyes (26 percent) and associated with three variables: greater IOP fluctuation, argon laser trabeculoplasty and older age. In their model, IOP fluctuation in the low mean IOP group was associated with visual field progression. This association was not seen in the high mean IOP group.Given these findings, the authors suggest that clinicians may want to rethink target pressure, perhaps considering IOP modulation rather than IOP reduction when exploring treatment options.