Protocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma.
OBJECTIVE
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.
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong.
Poemen P M
PP
Chan
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong.
Christopher K S
CK
Leung
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong.
Vivian
V
Chiu
Department of Ophthalmology, The University of Hong Kong, Hong Kong.
Rita
R
Gangwani
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong.
Abhishek
A
Sharma
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong.
Sophie
S
So
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong Translational Research for Equitable Eyecare, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong, China ORBIS International, New York, USA.
Nathan
N
Congdon
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D018450:Disease Progression; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology; D028761:Withholding Treatment
D000959:Antihypertensive Agents
Epidemiology; Glaucoma