Lower target IOP when?

• A. Long-term stable patients
• B. After cataract surgery
• C. New significant risk factors (like disc hemorrhage)
• D. In all patients

Answer: (C)

Target IOP in glaucoma is individualized and adjusted based on how likely the disease is to progress. When new significant risk factors appear, you tighten the goal and aim for a lower IOP to reduce the chance of losing vision.

Disc hemorrhage is a key example of a risk factor that signals increased progression risk, even if overall IOP hasn’t risen. Its presence suggests unstable optic nerve perfusion and structural vulnerability, so lowering the target IOP helps protect against future damage. In contrast, long-term stability without new risk factors may be adequately managed with the current target, and overly aggressive lowering can expose patients to unnecessary treatment burden or side effects. After cataract surgery, IOP may drop modestly, but this doesn’t automatically mandate a lower target for every patient. Lowering the target in all patients isn’t appropriate because not everyone is at the same risk of progression.