Stopping Medication Results in IOP Increase in Patients with Open-angle Glaucoma

In patients with treated open-angle glaucoma, stopping glaucoma medication results in a dose-dependent intraocular pressure (IOP) increase, according to a study published in the American Journal of Ophthalmology. Central corneal thickness (CCT) and selective laser trabeculoplasty (SLT) were associated with reduced response to IOP lowering medications.

In this secondary analysis of pre-randomization data from the HORIZON study and the COMPASS study, 1400 eyes with primary open-angle glaucoma who were using 0 to 4 classes of topical IOP-lowering medication underwent Goldmann applanation tonometry before and after a protocol-defined washout period.

In patients using no medications, the change in IOP following washout was 0.2 (2.8) mmHg; in patients using 1, the change in IOP was 5.7 (3.3) mmHg; in patients using 3, the change in IOP was 6.9 (3.7) mmHg; in patients using 4, the change in IOP was 8.8 (5.0) mmHg; and in patients using 5, the change in IOP was 9.5 (4.1) mmHg (P < 0.001, Kruskal-Wallis test).

In patients on monotherapy, a difference in post-washout IOP change was not detected among individual prostaglandin analogues.

A greater number of glaucoma medications, higher unmedicated IOP, thinner CCT, lack of prior selective laser trabeculoplasty, and male sex were associated with greater IOP rise upon medication washout.

Reference

Johnson TV and Jampel HD. Intraocular pressure following pre-randomization glaucoma medication washout in the HORIZON and COMPASS trials. Am J Ophthalmol. 2020; Epub ahead of print. DOI: https://doi.org/10.1016/j.ajo.2020.04.008