HMN 2026: How Clinicians use intraocular pressure as continuous risk factor for glaucoma management

Clinicians seem to generally use intraocular pressure (IOP) as a continuous risk factor in their treatment patterns in patients with glaucoma, according to a study published online Jan. 8 in JAMA Ophthalmology.

Ashley Polski, M.D., from the University of Utah in Salt Lake City, and colleagues assessed how IOP levels ranging from 12 mm Hg to 25 mm Hg influence the decision to initiate or escalate glaucoma therapy in clinical practice. The analysis included data from the Sight Outcomes Research Collaborative ophthalmology repository for nearly 1.87 million clinic encounters (184,504 eyes of 94,232 unique patients) seen between October 2009 and January 2022.

The researchers found that the rate of IOP-lowering treatment increased with higher IOP levels, with the largest acceleration in treatment rate at IOPs of 22 mm Hg or higher. An indicator IOP of 22 mm Hg had a greater effect on treatment initiation (odds ratio, 1.11) versus lower indicator IOPs, using mixed-effects logistic regression modeling.

“We emphasize that while clinicians in our study appeared to largely use IOP as a continuous risk factor in their glaucoma treatment decisions, there may also be a lingering influence of the historical IOP cutoff on current clinical decision-making,” the authors write.

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