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Anthony P Khawaja, Michelle P Chan, David C Broadway, David F Garway-Heath, Robert N Luben, Jennifer L Y Yip, Shabina Hayat, Kay-Tee Khaw, Paul J Foster; Systemic Medication and Intraocular Pressure in a British Population: The EPIC-Norfolk Eye Study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4314.
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To determine the association between systemic medication use and intraocular pressure (IOP) in a population of older British men and women.
The EPIC-Norfolk Eye Study is a cross-sectional population-based study in the UK. IOP was measured using the Ocular Response Analyser. Three readings were taken per eye and the single best value of the Goldmann-correlated IOP considered. Participants were asked to bring their medication and related documentation to the examination, and these were recorded by a research nurse. The medication classes examined in the current analysis were α-blockers, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), β-blockers, calcium channel blockers (CCB), diabetic medication, diuretics, nitrates, statins, aspirin and other non-steroidal anti-inflammatory drugs (NSAID). We excluded participants with a history of glaucoma therapy or IOP asymmetry between eyes of >5 mmHg. We examined associations between medication use and mean IOP of both eyes using linear regression models adjusted for age, sex and body mass index. We further adjusted for other medication use, one at a time, to determine if associations were independent of other concurrent medication use.
There were complete data from 7093 participants with a mean age of 68 years (range 48-92); 56% were women. The figure presents the associations between medication use and IOP. Use of systemic β-blockers (-1.04 mmHg, 95% CI [-1.30, -0.79], p<0.001) and nitrates (-1.04 mmHg, 95% CI [-1.51, -0.58], p<0.001) were associated with lower IOP. Use of diabetic medication was associated with higher IOP (0.44 mmHg, 95% CI [0.02, 0.85], p=0.038). The observed associations between statin or aspirin use with IOP were no longer significant following adjustment for β-blocker use (Table).
This is the first population-based study to have demonstrated and quantified clinically significant differences in IOP among participants using systemic β-blockers or nitrates. The study findings may have implications for the management of glaucoma patients with co-morbidity, and may provide insight into the pathophysiological processes underlying IOP.
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