Keep IOP Below 17mm Hg for High Myopes to Prevent Vision Loss

Myopia severity should be integral to glaucoma management in confirmed patients as well as ocular hypertensives. Photo: Andrew Rouse, OD. Click image to enlarge. Because efforts to preserve vision in glaucoma center on lowering intraocular pressure (IOP), the metric has outsized importance in clinical care. Myopia increases glaucoma risk, but it’s unclear if the same “safe” eye pressure targets apply to everyone. However, evidence supporting the individualization of IOP management based on refractive status, particularly myopia degree, remains insufficient.Researchers from China followed glaucoma patients with different levels of myopia for five years and recently presented their results at ARVO 2026 in Denver. They found that the degree of myopia mattered greatly. Patients with high myopia lost their vision faster and needed a lower eye pressure to stay safe compared to those with mild or moderate myopia. Specifically, keeping eye pressure below 17mm Hg was critical for high myopia patients to prevent vision loss, whereas a higher pressure was acceptable for others.This prospective study aimed to quantify target IOP to avoid significant visual field progression in patients with primary open-angle glaucoma (POAG) with low (-3.00D to -0.50D), moderate (-6.00D to -3.00D) or high myopia (≤ -6.00D). Using data from 2021 that included POAG patients with at least five reliable 24-2 SITA tests over five years, a total of 247 patients (426 eyes) were analyzed (comprising 113, 145 and 168 eyes in the low, moderate and high myopia groups, respectively). After adjusting for age, central corneal thickness and baseline mean deviation (MD), a significant difference in MD progression rate was observed: high myopia (-0.30dB/year), moderate (-0.18dB/year) and low (-0.07dB/year). To better understand the relationship between myopia and glaucoma, see this feature. Analysis revealed that at IOP levels >13.2mm Hg, eyes with high myopia had a higher predicted risk of progression at any given IOP. To maintain a progression rate below -0.5 dB/year, the researchers say that the mean IOP should be kept below 17.1mm Hg for the high myopia group, compared to 19.8mm Hg and 19.2mm Hg for the low and moderate groups, respectively. Within the observed IOP range (9.46mm Hg to 20.87mm Hg), a threshold for rapid progression (<-1.0dB/year) was identified only for the high myopia group (19.9mm Hg).“Our study shows that eye doctors should consider how nearsighted a glaucoma patient is when setting their personalized treatment goal, as a one-size-fits-all approach may not protect vision effectively,” the researchers wrote in their abstract.Original abstracts ©2026 Association for Research in Vision and Ophthalmology. Click here for the source. Dai J, Fan X, Dong X, et al. Myopia severity influences target intraocular pressure in primary open-angle glaucoma: a five-year prospective cohort study. ARVO 2026 annual meeting.This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.