Glaucoma is not always a simple disease to diagnose or effectively treat. Those of us whose practice focuses on this condition can attest to that. Over the years I’ve attended many lectures by top experts who acknowledge caring for patients who they eventually realized were misdiagnosed or mismanaged. It’s no surprise that new research is showing that glaucomatous vision loss can progress even when IOP (eye pressure) seems to be well controlled.
Susanna and colleagues, in their prospective cohort study, have shed some light on why this might be. They found that corneal hysteresis and corneal thickness are risk factors in disease progression in patients with well controlled IOP.
Thankfully, glaucoma is generally a slow-moving condition. Technology helps mitigate the mysterious nature of the disease, but what is really needed is humility, vigilance and frequent follow-up. Our understanding of glaucoma is evolving, and it seems that the ability to withstand pressure as well as corneal properties and other as-yet-undiscovered factors may be more important predictors of outcome than snapshots of IOP. Like in real life, it’s not the amount of pressure we are under but how we deal with it that seems to matter.
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