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Protocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma
  1. Poemen P M Chan1,
  2. Christopher K S Leung1,
  3. Vivian Chiu1,
  4. Rita Gangwani2,
  5. Abhishek Sharma1,
  6. Sophie So1,
  7. Nathan Congdon1,3,4
  1. 1Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
  2. 2Department of Ophthalmology, The University of Hong Kong, Hong Kong
  3. 3Translational Research for Equitable Eyecare, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong, China
  4. 4ORBIS International, New York, USA
  1. Correspondence to Dr Nathan Congdon, Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon 510060, Hong Kong; ncongdon1{at}gmail.com

Abstract

Aim To investigate the safety and potential savings of decreasing medication use in low-risk patients with ocular hypertension (OH).

Methods Patients with OH receiving pressure-lowering medication identified by medical record review at a university hospital underwent examination by a glaucoma specialist with assessment of visual field (VF), vertical cup-to-disc ratio (vCDR), central corneal thickness and intraocular pressure (IOP). Subjects with estimated 5-year risk of glaucoma conversion <15% were asked to discontinue ≥1 medication, IOP was remeasured 1 month later and risk was re-evaluated at 1 year.

Results Among 212 eyes of 126 patients, 44 (20.8%) had 5-year risk >15% and 14 (6.6%) had unreliable baseline VF. At 1 month, 15 patients (29 eyes, 13.7%) defaulted follow-up or refused to discontinue medication and 11 eyes (5.2%) had risk >15%. The remaining 69 patients (107 eyes, 50.7%) successfully discontinued 141 medications and completed 1-year follow-up. Mean IOP (20.5±2.65 mm Hg vs 20.3±3.40, p=0.397) did not change, though mean VF pattern SD (1.58±0.41 dB vs 1.75±0.56 dB, p=0.001) and glaucoma conversion risk (7.31±3.74% vs 8.76±6.28%, p=0.001) increased at 1 year. Mean defect decreased (−1.42±1.60 vs −1.07±1.52, p=0.022). One eye (0.47%) developed a repeatable VF defect and 13 eyes (6.1%) had 5-year risk >15% at 1 year. The total 1-year cost of medications saved was US$4596.

Conclusions Nearly half (43.9%) of low-risk OH eyes in this setting could safely reduce medications over 1 year, realising substantial savings.

  • Epidemiology
  • Glaucoma

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