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Influence of Intraocular Pressure on Clinical Decision-Making in Glaucoma Management
Ashley Polski1, Ben J Brintz2, Rachel Hess3
1Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City.
JAMA Ophthalmology
|January 8, 2026
Summary
Clinicians generally treat glaucoma based on continuous intraocular pressure (IOP) levels, but a historical IOP threshold of 22 mm Hg still influences treatment decisions. Decision support tools could help clinicians better utilize IOP as a continuous risk factor.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Clinical Decision-Making
Background:
- Intraocular pressure (IOP) is a primary risk factor for glaucoma, and its reduction is the standard treatment.
- The specific influence of IOP levels on clinical decisions for glaucoma therapy initiation or escalation is not well understood.
Purpose of the Study:
- To investigate how varying intraocular pressure (IOP) levels impact clinical decisions regarding the initiation or escalation of glaucoma therapy.
- To analyze the relationship between specific IOP measurements and treatment adjustments in glaucoma management.
Main Methods:
- A retrospective, multicenter cohort study utilizing the Sight Outcomes Research Collaborative (SOURCE) data repository.
- Inclusion of clinic encounters for glaucoma patients with IOPs between 12 mm Hg and 25 mm Hg from October 2009 to January 2022.
- Analysis of treatment initiation (medication, laser, surgery) based on IOP levels using mixed-effects logistic regression.
Main Results:
- The study analyzed 1,866,801 clinic encounters from 94,232 patients.
- Treatment initiation rates for glaucoma increased with higher IOP levels.
- A significant acceleration in treatment initiation was observed at IOPs of 22 mm Hg or higher, with this threshold showing a notable influence on decisions (OR, 1.11).
Conclusions:
- While clinicians increasingly view IOP as a continuous risk factor, the traditional 22 mm Hg cutoff may still guide treatment decisions in glaucoma.
- Further development of clinical decision support systems is recommended to aid clinicians in consistently applying IOP as a continuous risk factor.
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