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Adherence With the Use of Target Intraocular Pressure for Glaucoma Patients in a Large University Practice

Purpose:To determine how often glaucoma specialists set a target intraocular pressure (IOP) and how they respond when the target is not achieved. Methods:We reviewed 250 randomly selected charts of glaucoma patients seen by 5 glaucoma specialists to identify whether a target IOP was specifically set and to detail the plan of action when the target was exceeded. Results:A target IOP was present for at least 1 eye in 66% of patients (165/250). Among the patients of 5 physicians, the percentage with a target IOP for both eyes ranged from 90% to 34%. Half of eyes with no target had an explaining feature, whereas the other half did not. The study visit IOP exceeded the target in at least 1 eye in 29% (50/173) of patients. When the target was not met, 66% (33/50) had a notation of action taken, with no significant difference among physicians in whether any action was taken (P=0.64). The significant differences among the 5 physicians in the use of target IOP were potentially associated with patient demographic and clinical features, such as age, race, treatment intensity, and visual field damage, which differed among the 5 practices (all P<0.05). Conclusions:Target IOP was recorded in the large majority of patient charts, but its use varied by physician and patient characteristics. On nearly one third of visits, IOP exceeded the target, indicating the need for active decision-making and management changes.