PT  - JOURNAL ARTICLE
AU  - Poemen P M Chan
AU  - Christopher K S Leung
AU  - Vivian Chiu
AU  - Rita Gangwani
AU  - Abhishek Sharma
AU  - Sophie So
AU  - Nathan Congdon
TI  - Protocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma
AID  - 10.1136/bjophthalmol-2014-306014
DP  - 2015 Sep 01
TA  - British Journal of Ophthalmology
PG  - 1245--1250
VI  - 99
IP  - 9
4099  - http://bjo.bmj.com/content/99/9/1245.short
4100  - http://bjo.bmj.com/content/99/9/1245.full
SO  - Br J Ophthalmol2015 Sep 01; 99
AB  - 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.