How to assess IOP Peak and its Importance in Glaucoma Management

Elevated intra-ocular pressure (IOP) and mean IOP are considered the main risk factors for the development and progression of glaucoma. However, some patients still progress with IOP apparently in the target range. This observation has been explained on the basis that other non-IOP dependent risk factors are contributing to the glaucoma pathogenesis in these individuals. An alternative explanation is that progression occurs at least in - part due to high IOP peaks not detected during routine eye examinations. Several studies have demonstrated that peak IOP may be a better predictor of glaucoma progression. IOP peak assessment has been used recently to verify if the peak pressure of a given patient is in target range, to evaluate glaucoma suspect risk, the efficacy of hypotensive drugs and to detect early loss of IOP control. These are important aims to be addressed in glaucoma management. Several methods have been described to assess IOP peaks. The costs and labor involved in this make the determination of the 24-hour IOP or contact lens-sensor are difficult if not impossible in all patients. Recently the water drinking test (WDT) has been used as a surrogate marker for outflow reserve to detect IOP instability and to estimate IOP peak pressure. Peak IOP elicited by this test may be an indicator for the likelihood of progression and efficacy of hypotensive drugs the aim this manuscript is to present the importance of detecting IOP peaks in glaucoma management.