1. Both ß-blockers (-0.92 mmHg, p<0.001) and nitrates (-0.63 mmHg, p=0.011) were associated with a significantly lower intraocular pressure.
2. Statins and aspirin were initially associated with lower intraocular pressure, but were found to be due to concurrent use of ß-blockers.
Evidence Rating Level: 2 (Good)
Study Rundown: In this study, a large European patient database was used to identify whether any systemic medication classes were correlated with decreased intraocular pressure (IOP). The authors found that 2 specific classes were associated with a significantly lower IOP – ß-blockers (-0.92 mmHg, p<0.001) and nitrates (-0.63 mmHg, p=0.011). The use of ß-blockers has been previously associated with a reduced risk of glaucoma. Strengths of the study include the large patient database. Limitations in this study include the use of a noncontact tonometer for IOP measurement (instead of the gold standard of Goldmann tonometry), as well as patient medication list being self-reported. In addition, it is unclear whether the absolute IOP difference of ~1 mmHg in patients on these medications will have a large clinical impact. Nonetheless, this is the first study to link nitrates to decreased IOP, and reaffirms the impact of systemic ß-blocker therapy. The study is also the first to disprove an association between statins and decreased IOP, which had been previously reported. This study suggests that ophthalmologists should be aware of the impact of patients’ medication lists.
Relevant Reading: Systemic antihypertensive medical and incident open-angle glaucoma
In-Depth [cross-sectional study]: Over 7,000 Europeans from the EPIC patient database were studied. IOPs of both eyes were measured using noncontact tonometry and averaged. All patients self-reported their medication lists. Medication classes that were reviewed included ACE inhibitors, ARBs, ß-blockers, CCBs, diuretics, nitrates, statins, aspirin, insulin, other antiglycemics, and other NSAIDs. Multivariate regression models were created to assess for associations between medication and IOP after adjustment for age, gender, hemoglobin A1c levels, and BMI. After removal of confounders, the use of ß-blockers and nitrates were independently associated with decreased IOP. The association remained even when adjusted for blood pressure and heart rate. Statin and aspirin use was also found to have a significant association with IOP, but was due to concurrent ß-blocker use. These data may be important to consider when an ophthalmologist is considering ocular antihypertensive therapy.
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