How should I monitor intraocular pressure in patients diagnosed with primary open-angle glaucoma?

Intraocular pressure (IOP) monitoring in patients diagnosed with primary open-angle glaucoma (POAG) should be performed using Goldmann applanation tonometry (slit lamp mounted) at each assessment. This is the recommended standard method for accurate IOP measurement in these patients.

At each clinical episode, IOP should be assessed alongside other tests such as optic nerve head examination and visual field assessment to evaluate disease progression and risk of sight loss.

The frequency of reassessment depends on the control of IOP and the risk or evidence of glaucoma progression:

• If no progression is detected and IOP is controlled, reassessment can be scheduled between 12 and 18 months.
• If there is uncertain progression or progression without IOP control, reassessment should be more frequent, between 1 and 4 months or even 1 to 2 months depending on clinical judgement.
• If no progression is detected but the patient is at high clinical risk, reassessment should occur between 6 and 12 months.

Clinical judgement should guide the exact timing of follow-up appointments within these intervals, considering the impact of any new treatments started.

Alternative methods of IOP assessment may be used if standard methods are not possible due to patient factors, but Goldmann applanation tonometry remains the preferred method.