“While we have a lot of studies, major trials that give us the target range pressures, it may not be the absolute value of the pressure that you should reach for in every single patient,” said Dr. Chang. “But instead, start looking at what their individualized rates of progressions are over time.”
He pointed out that glaucoma doesn’t change overnight. It might be worthwhile to “sacrifice a few neurons” to avoid subjecting patients to a treatment that may cause side effects, he said. “What we’re really getting at here is their personalized rate of progression.”
He uses a grid to figure out what treatment might work best, and to present it to the patient. On the left column is “high-efficacy, but high side-effects” treatments, like filtering surgery. On the right is “watchful waiting.” In between are treatments with medium efficacy and medium risk. The faster the patient’s disease is progressing, the farther the left the patient belongs, and vice versa.
Dr. Chang still sets initial target pressures, and he lowers the patient’s pressure if he thinks the patient’s condition is deteriorating. “That’s what I’m focusing on, using visual fields maximally… to know are they getting a little bit worse therefore I’m going to think about all the new treatments available.”