What should we do before starting IOP lowering treatment?

• A. Start therapy immediately
• B. Obtain multiple untreated IOP measurements
• C. Do imaging
• D. Check blood pressure

Answer: (B)

Establishing a reliable baseline by obtaining multiple untreated intraocular pressure measurements is essential. Intraocular pressure can fluctuate throughout the day due to natural diurnal variation, posture, activity, and measurement technique. Relying on a single reading can misrepresent true pressure, because one elevated value might be a temporary spike rather than persistent elevation. By collecting several untreated measurements at different times, you confirm whether the IOP is consistently high and warrant treatment, rather than reacting to a one-off number. This baseline also helps tailor how aggressively to lower pressure and provides a solid reference for monitoring response once therapy begins. Imaging and systemic factors like blood pressure are important parts of glaucoma care, but they don’t substitute for confirming an untreated, sustained IOP elevation before starting treatment. Jumping to therapy after a single reading risks unnecessary medication exposure and over- or under-treatment.