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Certain systemic medications may modestly impact glaucoma risk

Roshini Claire Anthony
18 Jan 2017

The use of certain systemic medications may influence intraocular pressure (IOP), and potentially, glaucoma risk, according to a post hoc analysis of the SEED* study.

“IOP is the only modifiable risk factor for glaucoma, and lowering IOP prevents the development and progression of the disease. Our findings indicate that patients with glaucoma may potentially be at risk of higher or lower IOP, depending on medication class, and this would in turn affect management of IOP control,” said the researchers.

In a multiple linear regression analysis, the use of oral systemic β-blockers was associated with a 0.45 mm Hg lower IOP (95 percent confidence interval [CI], -0.65 to -0.25 mm Hg; p<0.001). [JAMA Ophthalmol 2017;doi:10.1001/jamaophthalmol.2016.5318]

In contrast, the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers was associated with 0.33 mm Hg (95 percent CI, 0.08 to 0.57 mm Hg; p=0.008) and 0.40 mm Hg (95 percent CI, 0.05 to 0.75 mm Hg; p=0.02) higher IOP, respectively.

The use of statins was also associated with elevated IOP (0.21 mm Hg higher, 95 percent CI, 0.02 to 0.4 mm Hg; p=0.03), as was the use of sulfonylureas (0.34 mm Hg higher, 95 percent CI, 0.05 to 0.63 mm Hg; p=0.02).

Study subjects in this analysis were 8,063 individuals from the three main racial/ethnic groups in Singapore (mean age 57 years, 50.9 percent female). Distribution across ethnicities was similar (34.2 percent Malay, 33.2 percent Chinese, 32.6 percent Indian). Individuals with glaucoma, previous ocular surgery or trauma, or IOP asymmetry >5 mm Hg between eyes were excluded.

“Understanding [the association between systemic medications and IOP] may guide our management of patients with glaucoma who are receiving treatment for systemic comorbidities. Unexpected associations may [also] point to previously unknown biological mechanisms underlying the regulation of IOP, which may in turn lead to new treatments,” said Drs Paul Foster and Anthony Khawaja from the Moorfields Eye Hospital NHS Foundation Trust and University College London Institute of Ophthalmology, London, England, in a separate editorial. [JAMA Ophthalmol 2017;doi:10.1001/jamaophthalmol.2016.5335]

The researchers acknowledged that the one-time measurement of IOP was a limitation as it did not account for potential fluctuations in IOP and their effects. Furthermore, patient compliance with medication was not accounted for and the duration and dosage of medication could potentially impact the findings, they said. 

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