GLAUCOMA: Edited by Donald L. BudenzManagement of the glaucoma patient progressing at low normal intraocular pressureWang, Sophia Y.; Singh, KuldevAuthor Information Department of Ophthalmology, Stanford University, Byers Eye Institute, Palo Alto, California, USA Correspondence to Sophia Y. Wang, Byers Eye Institute, 2452 Watson Court, Palo Alto, CA 94015, USA. Tel: +1 650 497 5790; fax: +1 650 565 8297; e-mail: firstname.lastname@example.org Current Opinion in Ophthalmology: March 2020 - Volume 31 - Issue 2 - p 107-113 doi: 10.1097/ICU.0000000000000640 Buy Metrics Abstract Purpose of review Patients with glaucoma with disease progression despite low or normal intraocular pressure (IOP) present special challenges to the treating clinician. Treatment goals may depend on whether patients have apparent low IOP with concurrent treatment or have low IOP at baseline without treatment. We review the diagnostic and therapeutic approaches to these patients. Recent findings Apparent progression at low IOP should start with confirmation of IOP, made easier by devices enabling patient home self-tonometry. Suspected visual field progression should be confirmed by repeat testing prior to advancement of therapy. Trabeculectomy remains the most effective surgical method of achieving long-term success, particularly when there is a low starting IOP. Drainage tube implantation or the use of novel micro-incisional non-bleb-forming procedures are less likely to be successful in achieving low IOP goals. Summary Diagnostic testing is important in confirming progressive glaucomatous disease at low IOP levels. The most effective way of slowing the progression of glaucoma in a patient with low IOP is to lower the IOP further, sometimes to single digit levels, which is most often achievable with trabeculectomy. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.