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    Numerous issues underlie unexplainable glaucoma progression

    When glaucoma is progressing despite good intraocular pressure (IOP) control, clinicians should consider a variety of issues before advancing patients along the therapeutic ladder, said Robert Stamper, MD.

    “We know from population studies that the incidence, severity, and progression of glaucoma consistently correlate with elevated IOP,” said Dr. Stamper, professor of clinical ophthalmology and director emeritus of the Glaucoma Service, University of California-San Francisco. “IOP reduction is currently the only treatment we can provide to patients with glaucoma. Therefore, it is important to explore situations associated with undetected IOP elevation.

    “However, recognizing that glaucoma progresses over a decade in about 20% of patients despite good in-office, IOP control and that somewhere between 5% and 11% of patients with glaucoma become blind even with the best of care,” he added. “it is also worthwhile to consider other potentially modifiable factors that can explain the progression and address those problems before escalating into more aggressive therapeutic territory.”

    Providing a checklist for patient evaluation, Dr. Stamper reminded colleagues–during the Glaucoma Symposium CME at the 2016 Glaucoma 360 meeting–to examine the eyes for exfoliative disease, which has been found to be a risk factor for glaucoma progression.

    “If there is exfoliative disease, you may need to be more aggressive in your treatment,” Dr. Stamper said.

    Gonioscopy and pachymetry

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