Elevated intraocular pressure (IOP) is the major risk factor for glaucoma. In the clinic, the response to elevated pressure and thus the risk for development of glaucoma differs among individuals. We took advantage of our ability to subject postmortem human eyes from the same individual to physiological and elevated pressure in a perfused outflow model and compared individual patterns of gene expression under pressure. The architecture of the trabecular meshwork, tissue responsible for the maintenance of IOP, was conserved. We performed two sets of experiments. The first set (n ϭ 5, 10 eyes) used Affymetrix GeneChips, identified the 20 most pressure-altered genes in each individual, and compared their pressure response in the other four. The second set (n ϭ 5, 10 eyes) selected 21 relevant trabecular meshwork genes and examined, by real-time TaqMan-PCR, the rank of their abundance and of their pressure differential expression in each individual. The majority of the up-and downregulated top-changers of each individual showed an individual response trend. Few genes were general responders. Individual responders included STATH, FBN2, TF, OGN, IL6, IGF1, CRYAB, and ELAM1 (marker for glaucoma). General responders included MMP1, MMP10, CXCL2, and PDPN. In addition, we found that although the relative abundance of selected genes was very similar among nonstressed individuals, the response to pressure of those same genes had a marked individual component. Our results offer the first molecular insight on the variation of the individual response to IOP observed in the clinical setting. individual response; trabecular meshwork; microarrays THE INTRAOCULAR PRESSURE (IOP) of the human eye under normal physiological conditions is 10 -22 mmHg (mean 16 Ϯ 6 mmHg) (58), while the pressure of the episcleral veins, site of the aqueous humor drainage outside the eye, is 8 -9 mmHg (24). This pressure differential is essential to maintain the ocular globe inflated. Increased changes in IOP create a mechanical stress situation that, in a not well understood manner, is transmitted to the back of the eye and exerts damage to the retinal ganglion cells (RGC) and to their axons (optic nerve). Death of RGCs impedes transmission of the visual signal to the brain and results in progressive loss of visual field and irreversible blindness. The resulting disease is glaucoma, the second leading cause of blindness worldwide (49). Elevated IOP is the major risk factor for glaucoma, and lowering IOP is the only currently available treatment for all types of glaucoma.The tissue responsible for maintaining the differential pressure in the eye is the outflow tissue, formed by the trabecular meshwork and the single cell layer lining the Schlemm's canal. This outflow tissue (from now on referred to as the "trabecular meshwork") is avascular, it is localized at the angle formed by the cornea and the iris, and, in humans, is the main route for the outflow of aqueous humor (9). The trabecular meshwork consists of layers with different cell types (uveal, cor...