Jian Ge, MD., Ph.D.

Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
Intraocular pressure (IOP) plays an fundamental role in the pathogenesis of glaucoma and many large scale randomized clinical trials have proved that lowering IOP is the only effective way to retard the deterioration of progressive optic neuropathy. However, it turns out that the nature of IOP is far from what we used to consider it as to be. In the current presentation, we aim to re-understand the profound meaning of IOP, by reviewing its classical definition to the most-updated knowledge.

IOP is maintained by the dynamic balance between the secretion and outflow of aqueous humor. However, autonomic nervous system and human biological rhythms lead to its very various curve, ranging from the brief and abrupt fluctuation, like surge of IOP, to the relatively long and gentle change, like long-term fluctuation. All these characters, combined with the effect of the eyeball's structure and diversity among ethnicities, depict the distribution of IOP. Awareness of this offers a new insight into the clinical strategy to lower IOP, that we should not aim to lower IOP to a definite value, but to an individually safe level. This also indicates that future “perfect medications” should come with the ability to maintain the IOP in the target level with as little surge and fluctuation as possible. 

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