Association of calcium channel blockers use with visual field progression in glaucoma clinics

Abstract

Purpose : To investigate the relationship between exposure to systemic calcium channel blockers (CCBs) and visual field (VF) progression in a large patient cohort.

Methods : We extracted VF data, demographics, and systemic medication information for 73,990 patients from five glaucoma clinics in England. VFs performed after incisional glaucoma surgery were excluded. We selected eyes with ≥ 5 reliable 24-2 SITA VFs (false positive rate < 15%) over ≥4 years and ≥2 tests with VF loss as estimated by Mean Deviation (MD) < -2 dB. We randomly selected one eye per patient (14,475 eyes; 133,505 tests) and identified 1,426 patients exposed to CCBs. We studied the effect of CCB exposure on MD progression with a Linear Mixed Model (LMM), with random intercepts and slopes. The MD was the response variable. The interaction between CCB exposure (dichotomous) and time (continuous) modeled the difference in rate of progression (RoP) between exposed and non-exposed. For our main analysis, we compared the exposed group to a control group, selected through multivariable (MV) propensity score (PS) matching. A secondary analysis was performed with a MV-LMM on the whole cohort; as for the main LMM, interactions between the additional predictors and time modeled their effect on RoP. Variables in the PS and MV-LMM, selected via a causal diagram, are reported in the Figure.

Results : Participant demographics are reported in the Table. CCB users had a slower RoP (Estimate [95%-Confidence Interval]: -0.29 [-0.32, -0.27] dB/year) compared to PS-matched controls (-0.34 [-0.37, -0.31] dB/year, p = 0.022). The results from the MV-LMM are shown in the forest plot in the Figure and confirmed the association between CCB exposure and faster RoP (p = 0.0006). Anti-hypertensives (other than nitrates and systemic beta-blockers) were also significantly associated with slower RoP. Systemic corticosteroids were associated with faster RoP. Older age and more positive baseline MD and Pattern Standard Deviation were associated with faster RoP . Female sex was associated with a slower RoP. The association with race was not significant, but this cohort was 98% white.

Conclusions : In this large clinical cohort, CCB exposure was significantly associated with a slower VF deterioration rate, after multivariable adjustment. Further studies are needed to replicate this finding and elucidate the mechanistic link between glaucoma progression and CCBs.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.