Protocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma.

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.

• Authors: Poemen P M Chan, Christopher K S Leung, Vivian Chiu, Rita Gangwani, Abhishek Sharma, Sophie So, Nathan Congdon
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 99 Issue 9 Pg. 1245-50 (Sep 2015) ISSN: 1468-2079 [Electronic] England
• PMID: 25733528 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Antihypertensive Agents

Topics

• Adult
• Aged
• Antihypertensive Agents (therapeutic use)
• Clinical Protocols
• Disease Progression
• Female
• Glaucoma (diagnosis, physiopathology, prevention & control)
• Humans
• Intraocular Pressure (drug effects)
• Longitudinal Studies
• Male
• Middle Aged
• Ocular Hypertension (drug therapy, physiopathology)
• Prospective Studies
• Risk Factors
• Time Factors
• Visual Field Tests
• Visual Fields (physiology)
• Withholding Treatment