Conventional guidelines call for a step-wise approach with modest IOP targets and clinicians watching and waiting to see if glaucoma progresses or IOP increases before intensifying therapy. For example, the European Glaucoma Society says a target IOP of less than 18 mm Hg with a reduction of at least 30% "may be sufficient" in moderate glaucoma.
Instead, Dr. Ahmed proposed aggressively treating glaucoma from the start, aiming for a lower IOP while taking into account compliance and risks.
Adding a third or fourth medication may not be effective in achieving a lower IOP, he said, citing a 2004 study by Neelakantan et al. in J Glaucoma.
One reason may be compliance. Across 34 studies, non-adherence ranged from 4.6% to 80%, and non-persistence ranged from 50% to 75% over 12 months.