An article in EyeNet reminds us to think hard about ocular perfusion pressure, especially in low-tension glaucoma patients or “regular” glaucoma patients who continue to deteriorate despite good IOP. You may need to speak to the cardiologist and get the patient off beta blockers or other anti-hypertensives which are reducing the pressure head going to the optic nerve. Perhaps a diuretic would be a better idea. I know I had this conversation once when one of my patients, in his early 50’s, was going down the toilet with IOP around 13 after a phaco-trab. I also recommend a second opinion for the patient’s peace-of-mind when he continues to deteriorate despite excellent medical/surgical outcomes.