Target Intraocular Pressure and Personalized Medicine in Glaucoma: Balancing Precision, Patient Autonomy, and Evolving Treatment Paradigms

The establishment of a target intraocular pressure (IOP) remains the cornerstone of therapeutic intervention in glaucoma. However, the paradigm for defining this target has shifted dramatically from a population-based threshold to a fluid, individualized estimate that integrates a multitude of clinical and personal factors. The emergence of personalized medicine, propelled by advances in pharmacogenomics, microinvasive glaucoma surgery, digital health technologies, and a deepened commitment to patient-centred care, is fundamentally reshaping glaucoma management. This review synthesizes current evidence to explore the evolution of the target IOP concept, critically appraises the role of precision medicine tools in refining therapeutic strategies, and examines the ethical imperative of incorporating patient autonomy through shared decision-making. We argue that the future of glaucoma care necessitates a holistic model where a dynamically adjusted, personalized target IOP is situated within a collaborative framework that balances algorithmic precision with individual patient context and values.