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Hamideh S. MOAYEDPARDAZI, Alexander Barash, Natalie C. Cheung, Janet B. Serle; The Benefits and Limitations of Adding a Third or Fourth Medication to a Glaucoma Patient’s Regimen. Invest. Ophthalmol. Vis. Sci. 2011;52(14):256.
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To determine the efficacy of advancing to triple or quadruple medical therapy in glaucoma patients.
A retrospective chart review of glaucoma patients who were advanced to three or four ocular hypotensive medications between 2006 and 2010. Baseline IOP and Humphrey Visual Field (HFA) data were collected up to 12 months before advancing therapy. After advancing therapy IOP measurements were recorded every three months up to 15 months; HFA data was collected for up to 15 months.
Of the 155 patient charts reviewed, 95 met the inclusion criteria (at least 18 years of age and on < 4 medications). 62 patients were placed on a 3rd medication, 33 on a 4th medication. Of the 63 patients on a 3rd medication, 23 were later placed on a 4th medication. After addition of a 3rd medication, IOP reductions (p<0.05) were observed for at least 12 months. 17.7% of triple therapy and 25.0% of quadruple therapy patients required glaucoma laser or surgery. Fourteen (22.6%) patients on three medications and 13 (23.2%) patients on four medications were lost to follow-up. The mean deviation (MD) before advancement in therapy was -6.52±6.22 dB (N=36) and -7.64± 6.92 dB (N=21) for triple and quadruple therapy patients respectively. Mean MD was unchanged over 15 months.
Advancement to triple glaucoma drug therapy was associated with a significant reduction in IOP for up to 12 months, and can be considered as a treatment option in patients needing additional IOP reduction. The addition of a fourth drug appears to have a limited effect on IOP.
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