Association of commonly used systemic medications with glaucoma prevalence and intraocular pressure across Europe: the E3 Consortium

International audiencePurpose : To investigate the association of common systemic medication use with intraocular pressure and glaucoma prevalence in the European population.Methods : We examined associations of systemic medication use with intraocular pressure and glaucoma prevalence in a meta-analysis of multiple cohort studies of the European Eye Epidemiology (E3) consortium. IOP measurement method and glaucoma ascertainment were according to individual study protocols. Multivariable regression (linear for IOP and logistic for glaucoma prevalence) was carried out in each study and results pooled using random effects meta-analysis. Age, sex, body-mass index and diabetes were included as co-variables. Associations of antidiabetic medications were evaluated only in diabetic subjects.Results : A total of 46,845 participants from 11 population-based studies from the E3-consortium were included. In the meta-analysis of our fully-adjusted multivariable models, beta-blocker usage was associated with a lower IOP (all beta-blockers: Beta=-0.33 mmHg, 95% confidence interval (CI)=-0.58 to -0.08; non-selective betablockers: Beta=-0.56, 95% CI=-0.92 to -0.21; selective betablockers: Beta= -0.40, 95% CI=-0.64 to -0.16). In the meta-analysis of our fully-adjusted multivariable models, usage of calcium-channel blockers was positively associated with a higher glaucoma prevalence (all calcium-channel blockers: OR=1.25, 95% CI=1.05 to 1.50; selective calcium-channel blockers with mainly vascular effects: OR=1.27, 95% CI=1.05 to 1.53; selective calcium-channel blockers with direct cardiac effects: OR=1.54, 95% CI=1.07 to 2.21). Usage of RAS-inhibitors, diuretics, alpha-agonists, statins, fibrates, non-selective monoamine reuptake inhibitors, selective serotonin reuptake inhibitors, and antidiabetic medications was not associated with IOP or glaucoma.Conclusions : Our study supports and quantifies the known IOP-lowering effect of systemic beta-blockers, but there was no evidence of an IOP-lowering effect of other commonly used systemic medications. The usage of calcium-channel blockers (both with vascular and direct cardiac effects) was associated with a higher prevalence of glaucoma but not with higher IOP. Further studies are required to probe whether this harmful association of calcium-channel blockers with glaucoma is causal