@article {Chan1245, author = {Poemen P M Chan and Christopher K S Leung and Vivian Chiu and Rita Gangwani and Abhishek Sharma and Sophie So and Nathan Congdon}, title = {Protocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma}, volume = {99}, number = {9}, pages = {1245--1250}, year = {2015}, doi = {10.1136/bjophthalmol-2014-306014}, publisher = {BMJ Publishing Group Ltd}, 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{\textpm}2.65 mm Hg vs 20.3{\textpm}3.40, p=0.397) did not change, though mean VF pattern SD (1.58{\textpm}0.41 dB vs 1.75{\textpm}0.56 dB, p=0.001) and glaucoma conversion risk (7.31{\textpm}3.74\% vs 8.76{\textpm}6.28\%, p=0.001) increased at 1 year. Mean defect decreased (-1.42{\textpm}1.60 vs -1.07{\textpm}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.}, issn = {0007-1161}, URL = {https://bjo.bmj.com/content/99/9/1245}, eprint = {https://bjo.bmj.com/content/99/9/1245.full.pdf}, journal = {British Journal of Ophthalmology} }