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

TitleProtocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma
Authors
Issue Date2015
PublisherBMJ Publishing Group. The Journal's web site is located at http://bjo.bmjjournals.com/
Citation
British Journal of Ophthalmology, 2015, v. 99 n. 9, p. 1245-1250 How to Cite?
AbstractAim: 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.
Persistent Identifierhttp://hdl.handle.net/10722/209430
ISSN
2020 Impact Factor: 4.638
2020 SCImago Journal Rankings: 2.016
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChan, PPM-
dc.contributor.authorLeung, CKS-
dc.contributor.authorChiu, V-
dc.contributor.authorGangwani, R-
dc.contributor.authorSharma, A-
dc.contributor.authorSo, S-
dc.contributor.authorCongdon, N-
dc.date.accessioned2015-04-17T05:16:52Z-
dc.date.available2015-04-17T05:16:52Z-
dc.date.issued2015-
dc.identifier.citationBritish Journal of Ophthalmology, 2015, v. 99 n. 9, p. 1245-1250-
dc.identifier.issn0007-1161-
dc.identifier.urihttp://hdl.handle.net/10722/209430-
dc.description.abstractAim: 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.-
dc.languageeng-
dc.publisherBMJ Publishing Group. The Journal's web site is located at http://bjo.bmjjournals.com/-
dc.relation.ispartofBritish Journal of Ophthalmology-
dc.titleProtocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma-
dc.typeArticle-
dc.identifier.emailLeung, CKS: cleung21@hku.hk-
dc.identifier.emailGangwani, R: gangwani@hku.hk-
dc.identifier.authorityLeung, CKS=rp02798-
dc.identifier.authorityGangwani, R=rp01883-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1136/bjophthalmol-2014-306014-
dc.identifier.pmid25733528-
dc.identifier.scopuseid_2-s2.0-84940586794-
dc.identifier.hkuros242912-
dc.identifier.volume99-
dc.identifier.issue9-
dc.identifier.spage1245-
dc.identifier.epage1250-
dc.identifier.eissn1468-2079-
dc.identifier.isiWOS:000360460000020-
dc.publisher.placeUnited Kingdom-
dc.identifier.issnl0007-1161-

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