TARGET PRESSURE OF

PRIMARY OPEN ANGLE GLAUCOMA

 INTRODUCTION

Quigley 1998 :
Glaucoma causes the second blindness in the world
50-70% is Primary Open Angle Glaucoma
Vaughan : POAG85-90% from all glaucoma patient
In Indonesian : Glaucoma can cause the blindness 
third  prevalensi 0,16% of population
Liesegang , 2003 :
Glaucoma is a group of diseases that
have in common a characteritic optic neuropathy
with associated visual function loss and
although elevated intraocular pressure
There are many risk factor for and
causes of glaucoma, but intraocular
pressure (IOP) is considered to be the
most important risk factor and the
only factor can be modified at the
present→lowering IOP is beneficial for
glaucoma
LITERATURE REVIEW

Means of IOP is 15 mmhg

The normal range is 12-20 mmhg
Resistance to aqueous outflow
across the trabecular meshwork
Schlemm’s canal system is
the main factor in IOP
The European Glaucoma Society guidelines
define the target IOP :
An estimate of the mean IOP obtained with
treatment that is expected to prevent
further glaucomatous damage
Others may argue that we cannot halt
glaucoma damage, but only reduce the rate
of progression
Determination of target IOP

1. Estimating the amount of glaucoma damage

2. Estimating the damaging IOP
3. Estimate the patient’s life expectancy
4. Consideration of the other risk factor for
progresion
5. Guesstimate the rate of progression of
glaucoma damage
The AAO recommends an adjustment
downward of target IOP based on responses
to following questions:
1. How severe is the existing optic nerve damage
2. How high is the IOP
3. How rapidly has the optic nerve damage
4. How many additional risk factor are present
One method of grading the severity of damage
recommended by the AAO is as follow

1. Mild : Characteristc optic nerve

abnormalities are consistent with
glaucoma, but the visual field is normal
2. Moderate : Visual field abnormalities
exist in one hemifield and are not
within 5˚ of fixation
One method of grading the severity of
damage recommended by the AAO is as
follow

3. Severe : Visual field abnormalities

exist in both hemifield or visual
loss is within 5˚ of fixation
Evaluation of optic disc topography
is therefore a cornerstone in
determining an individual target
pressure
Early Glaucoma :

A concentric enlargement of the optic disc

cup, a discrete asymmetry in the shape of
the rim, at the sides of the temporal
inferior or temporal superior disc octants,
or the presence of nerve fiber bundle
defects associated with elevated IOP
moderate structural damage :

Such as notching of the rim, has occurred at IOP

levels not exceeding 24 mmHg in the diurnal curve,
it is essential to aim for an IOP in the mid teens
advanced glaucomatous :
Alterations, occurring at statistically normal
pressure values, the IOP spikes of The diurnal
curve should not exceed 15 mmHg and should
be reduced even further, if glaucomatous optic
nerve atrophy is present
Monitoring patient POAG

The aim of monitoring

1. To detect proggression
2. To detect effect of treatment
3. To detect any change in health that may
affect the glaucoma management plan
The points at follow up patient

1. Briefly disscus the patient’s subjective well

being and visual function
2. Reassess risk factor
3. Reassess structure and function of the potic
nerve
4. Estimate rate of any proggression
5. Identify adverse effects of treatment
6. Assess compliance
7. Identify change in current medical and
ophthalmology problems
8. Reinforce appropriate patient information
- revise management
- plan follow up
Follow up timing

1. Glaucoma suspect : 6 - 24 months

2. Mild glaucoma : 6 – 12 months
3. Moderate : 4 – 6 months
4. Severe glaucoma : 1 – 4 months
Schematic drawing of the outer TM in normal eye-POAG