How to Set a Target IOP in Glaucoma
Last updated: October 2026
Short answer: target IOP is the pressure range at which you expect glaucoma to stop progressing within the patient's lifetime. There is no single number. A common starting point is a reduction of at least 25% from the untreated baseline, set lower for more advanced disease, faster progression, younger age and more risk factors, and revised whenever the disease progresses.
What to consider when setting a target
- Baseline IOP (untreated, ideally several readings, at different times of day)
- Stage of damage: early, moderate or advanced (optic disc and visual field)
- Rate of progression on serial fields and OCT
- Age and life expectancy: a young patient has many more years for damage to accumulate
- Other risk factors: thin CCT, disc haemorrhages, pseudoexfoliation, family history, myopia
- Fellow eye status and the patient's ability to cope with treatment
A practical starting framework
| Situation | Typical approach |
|---|---|
| Early glaucoma, slow or no progression | At least 20–30% reduction from baseline |
| Moderate glaucoma | A larger reduction, aiming for the lower end of normal |
| Advanced glaucoma or damage near fixation | Aggressive lowering; AGIS showed eyes kept below 18 mmHg at every visit had little average progression |
| Normal-tension glaucoma | Commonly a 30% reduction from baseline (as in CNTGS) |
These are starting points, not rules. See the evidence in landmark trials.
A target is a hypothesis, not a promise
- If the disease progresses at the target IOP, lower the target.
- If the disease is stable for years and treatment is burdensome, the target can sometimes be relaxed.
- Check adherence and drop technique before concluding that treatment has failed.
- Consider IOP fluctuation and peaks you might be missing (diurnal phasing).
- Remember the EMGT finding: each 1 mmHg of IOP lowering reduced the risk of progression by about 10%.
Frequently asked questions
What is a good target IOP for glaucoma?
There is no universal number. A common starting point is at least a 25% reduction from untreated baseline, with lower targets for advanced disease, fast progression or younger patients.
Should the target IOP be changed?
Yes. If glaucoma progresses at the current target, the target should be lowered. It is re-evaluated at every review.
What is the target IOP in normal-tension glaucoma?
Commonly a 30% reduction from baseline, following the Collaborative Normal-Tension Glaucoma Study, once progression has been documented.
Related: how to read a visual field, normal-tension glaucoma and disc haemorrhage.
📘 Want more exam-ready material? See iNotes 2027: Glaucoma on Kindle, or browse all my books.
Looking for an eye specialist in Ahmedabad? Read about glaucoma treatment at Sadbhaav or book a consultation with Dr. Dhaval Patel.