The Effect of Statins on Intraocular Pressure and on the Incidence and Progression of Glaucoma: A Systematic Review and Meta-Analysis

Abstract

Short-term statin use is associated with a reduced incidence of glaucoma. The effect of statins on glaucoma progression and IOP is uncertain.

A Meta-Analysis of Glaucoma Risk in Hyperlipidemic Individuals: A Critical Problem in Design

“…This flaw was also the same in the study of McCann et al 2 If the opposite directions in these two metaanalyses are true, the effect sizes would be underestimated in both studies. To understand the role of lipid dysregulation and its control of glaucoma risk, a clear definition of case (hyperlipidemic individuals not taking lipid-lowering drugs) and control groups in the cohort or case-control studies, if not the randomized controlled trials, must be done.…”

“…The recent article by McCann et al, 2 which reported on a meta-analysis of observational studies evaluating the effects of statins on glaucoma, demonstrated that ''shortterm statin use is associated with a reduced incidence of glaucoma.'' This is, to our knowledge, the first comprehensive review of statin use and glaucoma risk, but its implication would be limited because it is uncertain whether hyperlipidemia itself increases the risk of developing glaucoma.…”

Methodologic Assessment of the Systematic Reviews of Ophthalmic Adverse Drug Reactions Published in Ophthalmology Journals: A Systematic Review

“…The systematic reviews from McCann et al [17] to Ye et al [18] were the studies most compliant with methodological quality. Both studies have only one negative domain, which included, respectively, the presentation of the list of excluded articles and reasons of exclusion (domain 7), and the elaboration and publication of a protocol of the systematic review (domain 2) [17,18].…”

“…The systematic reviews from McCann et al [17] to Ye et al [18] were the studies most compliant with methodological quality. Both studies have only one negative domain, which included, respectively, the presentation of the list of excluded articles and reasons of exclusion (domain 7), and the elaboration and publication of a protocol of the systematic review (domain 2) [17,18]. All systematic reviews included the components of Population, Intervention, Comparator, Outcome in the description of research question and inclusion criteria (domain 1), described the results in detail (domain 8), using tables, and graphics if necessary, and reported any potential sources of conflict of interest (domain 16).…”

Statin Use and Open-Angle Glaucoma: Evidence From Observational Studies

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We read with interest the systematic review and meta-analysis on the effect of statins on intraocular pressure (IOP) and glaucoma incidence and progression by McCann et al 1 We would like to discuss the appropriateness of inclusion of studies in the systematic review, placement of studies in the metaanalysis, and the process of appraising the quality of evidence of the included studies.

APPROPRIATENESS OF INCLUSION OF STUDIES IN THE SYSTEMATIC REVIEWThe authors claim that the systematic review was to evaluate the effect of statins on glaucoma; the inclusion of studies with nonglaucoma cases could lead to erroneous conclusions. The authors included the case-control study by Owen et al, 2 which defined cases based on a combination of diagnostic codes for glaucoma or ocular hypertension and codes for prescription specific to glaucoma treatment.

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