In Brief | Association of Systemic Medication Use with Glaucoma and Intraocular Pressure 

Original Published In Opthalmology: September 2023
 

As populations age across the globe, how best to manage the range of concomitant diseases such as hypotension, diabetes, and other cardio-and neuro-vascular conditions becomes increasingly important. Glaucoma, one of the leading causes of visual impairment in older population, is one such condition.
 

In this recent study, published in Ophthalmology, researchers set out to determine which, if any, of the more commonly prescribed systemic medications was associated with an increased risk for developing raised intraocular pressure and glaucoma. Given that intraocular pressure is the only modifiable factor in the development of glaucoma, the results of this study could potentially assist in the development of alternative treatment protocols for patients.  

The study, a metanalysis, was conducted on 140,000 participants selected from 11 population cohort studies from 8 countries across Europe:

• Glaucoma analysis was conducted on 143 240 participants,

• IOP analyses on 47 177 participants

The following drug categories were included in the study: antihypertensive medications (β-blockers, diuretics, calcium channel blockers [CCBs], α-agonists, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers), lipid-lowering medications, antidepressants, and antidiabetic medication.

The researchers recorded the following results: 

Glaucoma:

• The use of CCBs was associated with a higher prevalence of glaucoma (odds ratio 1.23; 95% confidence interval, 1.08 to 1.39)

• This association was stronger for monotherapy of CCBs with direct cardiac effects  (odd ratio, 1.96; 95% confidence interval 1.23 to 3.12).

• No other antihypertensive, lipid-lowering, antidepressants or antidiabetic medications were associated with glaucoma. 

Intraocular Pressure:

• The use of systemic β-blockers was associated with a lower IOP (β coefficient, −0.33 mmHg; 95% CI, −0.57 to −0.08 mmHg). 

• Monotherapy of both selective systemic β-blockers and nonselective systemic β-blockers was associated with lower IOP. 

• A suggestive association was found between the use of high-ceiling diuretics and lower IOP but not when used as monotherapy. 

• No other antihypertensive, lipid-lowering, antidepressants or antidiabetic medications were associated with IOP.

The researchers note that a limitation of the study was the use of the metanalysis approach, in which the heterogeneity of the sample group may be limited. Nonetheless, the results were sufficiently robust to indicate the potentially harmful association of CCBs with the increased risk of glaucoma, particularly given the frequent use of these medications in this sample group. 

Access the original article 
 

1. Vergroesen, J. E., Schuster, A. K., Stuart, K. V., Asefa, N. G., Cougnard-Grégoire, A., Delcourt, C., Schweitzer, C., Barreto, P., Coimbra, R., Foster, P. J., Luben, R. N., Pfeiffer, N., Stingl, J. V., Kirsten, T., Rauscher, F. G., Wirkner, K., Jansonius, N. M., Arnould, L., Creuzot-Garcher, C. P., Stricker, B. H., … European Eye Epidemiology Consortium (2023). Association of Systemic Medication Use with Glaucoma and Intraocular Pressure: The European Eye Epidemiology Consortium. Ophthalmology, 130(9), 893–906. https://doi.org/10.1016/j.ophtha.2023.05.001  

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