Systemic Medication and Intraocular Pressure in a British Population

Abstract

ObjectiveTo determine the association between systemic medication use and intraocular pressure (IOP) in a population of older British men and women.DesignPopulation-based, cross-sectional study.ParticipantsWe included 7093 participants from the European Prospective Investigation into Cancer–Norfolk Eye Study. Exclusion criteria were a history of glaucoma therapy (medical, laser, or surgical), IOP asymmetry between eyes of >5 mmHg, and missing data for any covariables. The mean age of participants was 68 years (range, 48–92) and 56% were women.MethodsWe measured IOP using the Ocular Response Analyzer. Three readings were taken per eye and the best signal value of the Goldmann-correlated IOP value considered. Participants were asked to bring all their medications and related documentation to the health examination, and these were recorded by the research nurse using an electronic case record form. The medication classes examined were angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, α-blockers, β-blockers, calcium channel blockers, diuretics, nitrates, statins, insulin, biguanides, sulfonylureas, aspirin, and other nonsteroidal anti-inflammatory drugs. We examined associations between medication use and IOP using multivariable linear regression models adjusted for age, sex, and body mass index. Models containing diabetic medication were further adjusted for glycosylated hemoglobin levels.Main Outcome MeasuresMean IOP of the right and left eyes.ResultsUse of systemic β-blockers (−0.92 mmHg; 95% CI, −1.19, −0.65; P<0.001) and nitrates (−0.63 mmHg; 95% CI, −1.12, −0.14; P = 0.011) were independently associated with lower IOP. The observed associations between statin or aspirin use with IOP were no longer significant after adjustment for β-blocker use.ConclusionsThis is the first population-based study to demonstrate and quantify clinically significant differences in IOP among participants using systemic β-blockers or nitrates. Lower IOP observed in participants using statins or aspirin was explained by concurrent systemic β-blocker use. The study findings may have implications for the management of glaucoma patients with comorbidity, and may provide insight into the pathophysiologic processes underlying IOP.

Antihypertensive Medication Postpones the Onset of Glaucoma

“…Thus, hypertension was defined as a patient receiving ≥2 antihypertensive compounds. Because previous studies have shown a decreased risk of glaucoma in patients treated with systemic β-blockers or calcium channel inhibitors, 16,23,[35][36][37] it seems reasonable to interpret the present observed reduction of the risk of developing glaucoma in patients treated with antihypertensive as a causal effect of particular antihypertensive drugs. …”

The effect of hemodialysis on intraocular pressure

“…A populationbased study has investigated the association between the use of common systemic medications and IOP. 21 According to the results of that study, the use of systemic β-blockers and nitrates were independently associated with lower IOP. However, in the present study we did not find any effects of systemic β-blocker use on IOP decrease during HD.…”

Pharmacotherapy of Glaucoma

“…In another report, systemic beta-receptor antagonists and nitrates were associated with a lower IOP when effects of blood pressure were factored out. 104 In addition, retrospective analysis of patient data indicate that intake of statins is protective for glaucoma. 105 In the absence of randomized large-scale trials, it is, however, difficult to fully explore the impact of systemic therapies on glaucoma incidence and progression, because a disease-modifying effect of the underlying disease can never be ruled out.…”