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Use of Topical Intraocular Pressure–lowering Medications in the US Population

Results From the NHANES Study 1999 to 2014

Lowry, Eugene A. MD*,†,‡; Chansangpetch, Sunee MD§; Lin, Shan C. MD*,∥

doi: 10.1097/IJG.0000000000001315
Original Studies

Precis: We found no evidence of an increase in the number of Americans using topical intraocular pressure (IOP) medication or a number of drops used per patient from 1999 to 2014, although there were significant changes in the class of medications used.

Purpose: The purpose of this study was to determine changes in topical IOP-lowering medication use in the United States from 1999 to 2014.

Materials and Methods: A series of 8 nationally representative, weighted cross-sectional surveys of United States residents were performed every 2 years from 1999 to 2014. On 2-year cycles, professional interviewers performed in-home interviews of a representative sample of the nation as part of the National Health and Nutrition Examination Survey study. Participants were asked, “In the past month, have you used or taken medication for which a prescription is needed?” Adults over age 40 who responded to this question were included in the analysis. The primary outcome was number of US adults using topical IOP–lowering medication. Secondary outcomes included the number and types of medications used.

Results: There was no change in the number of adults using topical IOP–lowering medications over the time period studied (P=0.74) with 1.4% (95% confidence interval: 0.9%-1.8%) of US residents on IOP-lowering medications in 1999 to 2000 and 1.4% of US residents (95% confidence interval: 1.1%-1.8%) on topical medications in 2013 to 2014. There was no change in the number of medications per patient over the period of the study (P=0.14). There was a significant increase in the use of prostaglandin analogs and combination medications and a decrease in the use of β-blockers (all P<0.01).

Conclusions: In contrast to the increase in glaucoma medication use seen in several other developed nations, use in the United States remained stable from 1999 to 2014. This may be due to differential use of other procedures. Future studies of IOP-lowering medications incorporating the effect of new agents and minimally invasive surgeries are warranted.

*Department of Ophthalmology, University of California

Glaucoma Center of San Francisco, San Francisco, CA

Devers Eye Institute, Devers Eye Institute Glaucoma Service

Casey Eye Institute, Oregon Health and Sciences University, Portland, OR

§Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

Presented at ARVO Annual Conference in May 2018, Honolulu, HI.

Supported in part by an unrestricted grant from Research to Prevent Blindness, NY, NY, and That Man May See Inc., San Fransisco, CA. These supporting organizations had no role in the design or conduct of the research.

Disclosure: The authors declare no conflict of interest.

Reprints: Eugene A. Lowry, MD, Devers Eye Institute, Devers Eye Institute Glaucoma Service, 1040 NW 22nd Avenue, Portland, OR 97210 (e-mail:

Received January 31, 2019

Accepted June 15, 2019

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