Protocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma.
Chan Poemen P M, Leung Christopher K S, Chiu Vivian, Gangwani Rita, Sharma Abhishek, So Sophie, Congdon Nathan
AI Summary
This study found that nearly half of low-risk ocular hypertension patients could safely reduce glaucoma medications for one year, yielding significant cost savings without significant IOP change.
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.
MeSH Terms
Shields Classification
Key Concepts5
Among 69 patients (107 eyes, 50.7%) with ocular hypertension who successfully discontinued 141 medications and completed 1-year follow-up, the mean intraocular pressure (IOP) did not change significantly (20.5±2.65 mm Hg vs 20.3±3.40, p=0.397).
In 69 patients (107 eyes, 50.7%) with ocular hypertension who discontinued medications, the mean visual field pattern standard deviation (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.
One eye (0.47%) developed a repeatable visual field defect and 13 eyes (6.1%) had a 5-year risk of glaucoma conversion >15% at 1 year after discontinuing ocular hypotensive medication in patients with ocular hypertension.
Discontinuing ocular hypotensive medication in low-risk ocular hypertension patients resulted in a total 1-year cost saving of US$4596.
In a study of 212 eyes of 126 patients with ocular hypertension (OH) receiving pressure-lowering medication, 44 eyes (20.8%) had a 5-year risk of glaucoma conversion greater than 15%.
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