Systemic Medication Associations with Presumed Advanced or Uncontrolled Primary Open-Angle Glaucoma

Zheng, Wei; Dryja, Thaddeus P.; Wei, Zhongyuan; Song, Dongying; Tian, Haijun; Kahler, Kristijan H.; Khawaja, Anthony P.

doi:10.1016/j.ophtha.2018.01.007

Cited by 59 publications

(85 citation statements)

References 37 publications

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“…The finding of potentially more rapid progression with initiation of calcium channel blockers vs. thiazides was consistent with two previously published studies—a case control study, using logistic regression to assess the association of drugs and drug classes with primary OAG status by Zheng et al . and a prospective population‐base cohort study using multivariate logistic regression to study the association of antihypertensive medication with OAG by Muskens et al .…”

Section: Discussionsupporting

confidence: 89%

“…found that patients who had previous exposure to calcium channel blockers had a 1.8‐fold higher risk of developing OAG than patients who were not previously exposed to calcium channel blockers and may or may not have been exposed to other antihypertensive agents. The study by Zheng et al . found that patients with glaucoma filtration surgery were 26% more likely to have been exposed to calcium channel blockers at some point within the previous 5 years than matched controls.…”

Section: Discussionmentioning

confidence: 99%

“…found that patients with glaucoma filtration surgery were 26% more likely to have been exposed to calcium channel blockers at some point within the previous 5 years than matched controls. The effect was mainly driven by amlodipine, which was the most commonly prescribed drug in the class . In our study, eight drugs from three subtypes of calcium channel blockers were evaluated together.…”

Section: Discussionmentioning

confidence: 99%

“…Many drugs have unintended effects that may be either harmful or beneficial. Previous studies have identified several marketed systemic medications that have the potential to slow the progression of OAG . A crossover trial found that use of angiotensin II receptor blockers was correlated with lower intraocular pressure .…”

mentioning

confidence: 99%

“…A cohort study conducted using a large claims database found a dose‐dependent relationship between metformin use and reduced risk of developing OAG . Most recently, a study used data from a large healthcare claims database to screen 423 unique drug classes and found that exposure to selective serotonin reuptake inhibitor and fibric‐acid derivatives were associated with reduced risk of filtration surgery for OAG, whereas an increased risk was observed with calcium channel blockers …”

mentioning

confidence: 99%

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Using Healthcare Databases to Refine Understanding of Exploratory Associations Between Drugs and Progression of Open‐Angle Glaucoma

Wang

Rice

et al. 2019

Clin Pharma and Therapeutics

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We sought to refine understanding about associations identified in prior studies between angiotensin‐II receptor blockers, metformin, selective serotonin reuptake inhibitors, fibric‐acid derivatives, or calcium channel blockers and progression to glaucoma filtration surgery for open‐angle glaucoma (OAG). We used new‐initiator, active‐comparator cohort designs to investigate these drugs in two data sources. We adjusted for confounders using stabilized inverse‐probability‐of‐treatment weights and evaluated results using “intention‐to‐treat” and “as‐treated” follow‐up approaches. In both data sources, Kaplan–Meier curves showed trends for more rapid progression to glaucoma filtration surgery in patients taking calcium channel blockers compared with thiazides with as‐treated (MarketScan P = 0.15; Medicare P = 0.03) and intention‐to‐treat follow‐up (MarketScan P < 0.01; Medicare P = 0.10). There was suggestion of delayed progression for selective serotonin reuptake inhibitor compared with tricyclic antidepressants in Medicare, which was not observed in MarketScan. Our study provided support for a relationship between calcium channel blockers and OAG progression but not for other investigated drugs.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Using Healthcare Databases to Refine Understanding of Exploratory Associations Between Drugs and Progression of Open‐Angle Glaucoma

Wang

Rice

et al. 2019

Clin Pharma and Therapeutics

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Calcium Channel Blocker Use and Associated Glaucoma and Related Traits Among UK Biobank Participants

Kastner,

Stuart,

Montesano

et al. 2023

JAMA Ophthalmol

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ImportanceCalcium channel blocker (CCB) use has been associated with an increased risk of glaucoma in exploratory studies.ObjectiveTo examine the association of systemic CCB use with glaucoma and related traits among UK Biobank participants.Design, Setting, and ParticipantsThis population-based cross-sectional study included UK Biobank participants with complete data (2006-2010) for analysis of glaucoma status, intraocular pressure (IOP), and optical coherence tomography (OCT)–derived inner retinal layer thicknesses. Data analysis was conducted in January 2023.ExposureCalcium channel blocker use was assessed in a baseline touchscreen questionnaire and confirmed during an interview led by a trained nurse.Main Outcomes and MeasuresThe primary outcome measures included glaucoma status, corneal-compensated IOP, and 2 OCT-derived inner retinal thickness parameters (macular retinal nerve fiber layer [mRNFL] and macular ganglion cell–inner plexiform layer [mGCIPL] thicknesses). We performed logistic regression and linear regression analyses to test for associations with glaucoma status and IOP and OCT-derived inner retinal thickness parameters, respectively.ResultsThis study included 427 480 adults. Their median age was 58 (IQR, 50-63) years, and more than half (54.1%) were women. There were 33 175 CCB users (7.8%). Participants who had complete data for glaucoma status (n = 427 480), IOP (n = 97 100), and OCT-derived inner retinal layer thicknesses (n = 41 023) were eligible for respective analyses. After adjustment for key sociodemographic, medical, anthropometric, and lifestyle factors, use of CCBs (but not other antihypertensive agents) was associated with greater odds of glaucoma (odds ratio [OR], 1.39 [95% CI, 1.14 to 1.69]; P = .001). Calcium channel blocker use was also associated with thinner mGCIPL (−0.34 μm [95% CI, −0.54 to −0.15 μm]; P = .001) and mRNFL (−0.16 μm [95% CI, −0.30 to −0.02 μm]; P = .03) thicknesses but not IOP (−0.01 mm Hg [95% CI, −0.09 to 0.07 mm Hg]; P = .84).Conclusions and RelevanceIn this study, an adverse association between CCB use and glaucoma was observed, with CCB users having, on average, 39% higher odds of glaucoma. Calcium channel blocker use was also associated with thinner mGCIPL and mRNFL thicknesses, providing a structural basis that supports the association with glaucoma. The lack of association of CCB use with IOP suggests that an IOP-independent mechanism of glaucomatous neurodegeneration may be involved. Although a causal relationship has not been established, CCB replacement or withdrawal may be considered should glaucoma progress despite optimal care.

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Medical Management of Glaucoma

Catoira-Boyle

WuDunn

Cantor

et al. 2022

Albert and Jakobiec's Principles and Practice of Ophthalmology

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Systemic Medication Associations with Presumed Advanced or Uncontrolled Primary Open-Angle Glaucoma

Cited by 59 publications

References 37 publications

Using Healthcare Databases to Refine Understanding of Exploratory Associations Between Drugs and Progression of Open‐Angle Glaucoma

Using Healthcare Databases to Refine Understanding of Exploratory Associations Between Drugs and Progression of Open‐Angle Glaucoma

Calcium Channel Blocker Use and Associated Glaucoma and Related Traits Among UK Biobank Participants

Medical Management of Glaucoma

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