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Editors Selection IGR 9-4

Progression: Which IOP parameters predict progression?

Comment by Kuldev Singh on:

45758 Intraocular Pressure Control and Long-term Visual Field Loss in the Collaborative Initial Glaucoma Treatment Study, Musch DC; Gillespie BW; Niziol LM et al., Ophthalmology, 2011; 118: 1766-1773

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The work by Musch et al. (1063) from the Collaborative Initial Glaucoma Treatment Study (CIGTS) is the latest in a series of reports from large randomized clinical trials assessing which IOP parameters best predict disease progression. Given that these studies looked at different patient populations at various stages of the glaucoma continuum, had unique treatment algorithms and therapeutic goals as well as methods of data acquisition and analysis, it is not surprising that the findings from such studies vary substantially.The issue of which IOP parameter measured over the long term (mean, peak,range or standard deviation) is most important remains controversial and is a complex issue to say the least.

There is 'difficulty in assessing the importance of long term IOP variability as an independent risk factor for glaucoma progression'

Musch and colleagues show that in CIGTS, the maximum IOP as well as IOP range and standard deviation appear to be important determinants of IOP progression, particularly in subjects randomized to medical therapy. These findings somewhat contrast the elegant work from the Early Manifest Glaucoma Study showing that IOP mean rather than variability is the important predictor of disease progression.

There is currently no good evidence suggesting that long term IOP variability associated risk is an appropriate surrogate for risk related to short term IOP fluctuation over 24 hours

A recent editorial in the August, 2011 issue of Archives of Ophthalmology entitled 'Intraocular Pressure Variability and Glaucoma Risk: Complex and Controversial' points out some of the difficulty in assessing the importance of long term IOP variability as an independent risk factor for glaucoma progression.

There is currently no good evidence suggesting that such long term IOP variability associated risk is an appropriate surrogate for risk related to short term IOP fluctuation over 24 hours.

There is no doubt that the much anticipated development of a continuous 24-hour IOP monitoring device will be shed much light on which IOP parameters are most relevant to glaucomatous disease progression.

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