Managing patients with an overactive bladder and glaucoma: a questionnaire survey of Japanese urologists on the use of anticholinergics

Abstract

prescribing anticholinergics, and 45 (29%) routinely referred patients with such a history to ophthalmologists. To treat patients with OAB and glaucoma, 102 (66%) would prescribe anticholinergics if permission were available from the ophthalmologist, 33 (21%) chose other treatments and 17 (11%) abandoned treatment. Forty-nine urologists (32%) were currently prescribing anticholinergics to patients with glaucoma.As to knowledge about glaucoma, 132 (85%) urologists knew that there were two types of glaucoma and 98 (63%) knew about laser iridotomy. The proportion of urologists who knew of the two types of glaucoma and asked patients for this information was significantly higher in university than in general hospitals ( P < 0.05). CONCLUSIONSAlthough anticholinergic drugs can precipitate angle-closure glaucoma by pupillary block, they are not contraindicated in open-angle glaucoma or in angle-closure glaucoma that has already been treated by laser iridotomy. Not all urologists are aware of this difference, at least in Japan. Some urologists avoid anticholinergics in all patients with glaucoma, while others pay little attention to glaucoma. Routine history taking and referral to ophthalmologists allows many patients with OAB and glaucoma to benefit safely from anticholinergics. Moreover, clinicians should be aware of patients with OAB who have not been evaluated by ophthalmologists but who are at risk of angle-closure glaucoma.

Ocular Side‐effects of Urological Pharmacy

“…Visual loss has been reported after angle‐closure episodes induced by oxybutynin [8] and with other anticholinergic medications, e.g. propiverine [9]. If promptly diagnosed and treated then the prognosis is favourable.…”

“…A lack of understanding about glaucoma amongst doctors leads to confusion in the management of the OAB and glaucoma [9]. Both frequently coexist in the elderly; 30% of urologists withhold anticholinergic therapy in all patients with a history of any form of glaucoma [9]. Open‐angle glaucoma, by definition, has no element of mechanical obstruction to aqueous outflow and therefore anticholinergic medication is safe.…”

Bilateral Angle-Closure Glaucoma in a Young Female Receiving Cabergoline: A Case Report

“…Several types of drugs, such as adrenergic agonists, cholinergics, anti-cholinergics, sulfa-based drugs (e.g. topiramate), selective serotonin reuptake inhibitors, tricyclic and tetracyclic anti-depressants, anticoagulants, and antihistamines, have been reported to induce secondary acute angle-closure glaucoma [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12]. …”

Ophthalmic manifestations of urological drugs

“…Patients with open-angle glaucoma and treated, closed-angle glaucoma were started on oxybutynin with no adverse effects. 25 Recommendations on the use of anticholinergic drugs in glaucoma are given in Box 3.…”