The impact of achieving target intraocular pressure on glaucomatous retinal nerve fiber layer thinning in a treated clinical population

Estimate the effect of being below and above the clinician-set target intraocular pressure (IOP) on rates of glaucomatous retinal nerve fiber layer (RNFL) thinning in a treated real-world clinical population.Retrospective cohort study METHODS: 3,256 eyes (1,923 patients) with ≥ 5 reliable optical coherence tomography (OCT) scans and 1 baseline visual field test were included. Linear mixed-effects modeling estimated the effects of the primary independent variables (mean target difference [measured IOP - target IOP] and mean IOP, mmHg) on the primary dependent variable (RNFL slope, µm/year) while accounting for additional confounding variables (age, gender, race, baseline RNFL, baseline pachymetry, disease severity). A spline term accounted for differential effects when above (target difference > 0 mmHg) and below (target difference ≤ 0 mmHg) target pressure.Eyes below and above target had significantly different mean RNFL slopes (-0.44 vs. -0.71 µm/year, p < 0.001). Each 1 mmHg increase above target had a 0.143 µm/year faster rate of RNFL thinning (p < 0.001). Separating by disease severity, suspect, mild, moderate, and advanced glaucoma had 0.135 (p = 0.002), 0.116 (p = 0.009), 0.203 (p = 0.02), and 0.65 (p = 0.22) µm/year faster rates of RNFL thinning per 1 mmHg increase.Being above the clinician-set target pressure is associated with more rapid RNFL thinning in suspect, mild, and moderate glaucoma. Faster rates of thinning were also present in advanced glaucoma but statistical significance was limited by the lower sample size of eyes above target and the OCT floor effect.