Follow-up letters after glaucoma surgery tend to report the latest pressure or an average. Peak pressure — the highest reading between visits — was the stronger predictor of field loss after redo surgery.
Keep a running record of the highest post-operative IOP and note it in each letter. A single spike above target is a reason to act, even if the average looks fine.
- Record the highest IOP since surgery in each follow-up note.
- Consider diurnal or home tonometry when progression outpaces the clinic readings.
- Treat repeated spikes, not only a high mean.
Why it matters
A reassuring average can hide the spikes that damage the nerve.
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