Glaucoma associated with drug use: A real-world analysis using the FDA adverse event reporting system database.

<h2 id="aim">Aim</h2><ul><li>This study aims to assess the risk of drug-associated glaucoma and track its epidemiological characteristics using real-world data.</li></ul><h2 id="methods">Methods</h2><ul><li>Food and Drug Administration Adverse Event Reporting System (FAERS) reports from January 2004 to December 2023 were analyzed using disproportionality analysis and Bayesian Confidence Propagation Neural Network.</li></ul><h2 id="assesment-parameters">Assessment parameters</h2><ul><li>Drugs linked to glaucoma, evaluated risk levels, and compared drug-induced times across categories.</li></ul><h2 id="results">Results</h2><ul><li>In the FAERS database, 805 drugs were linked to glaucoma.</li><li>Disproportionality analysis found 46 drugs with significant risk, mainly adrenergic, antihypertensives, insulin, anticholinergics, VEGF inhibitors, and psychotropics.</li><li>Clobetasol propionate, umeclidinium, and fluocinolone acetonide were the top three high-risk drugs. Indacaterol, salmeterol, and umeclidinium had the shortest drug-induced times.</li><li>Anticholinergic meds had the shortest time. Detailed drug names and classifications can be seen in figure 1.</li><li>Females (62.5%) and the elderly (average age 63.5 ± 16.8 years) were mainly affected.<br>Reports of drug-associated glaucoma rose annually.</li><li>Schematic diagram depicting the mechanisms, representative drugs, and subsequent treatment options for drug associated glaucoma caused by different drug categories is represented in figure 2</li></ul><p><strong>Figure 1: Schematic diagram of different categories causing drug-associated glaucoma.</strong></p><figure class="image"><img style="aspect-ratio:727/402;" src="https://cdn.megawecare.com/GHBY/Internal-Images/opthal-fig-1.webp" width="727" height="402"></figure><p><strong>Figure 2: Schematic diagram illustrating the mechanisms, representative drugs, and subsequent treatment options for drug associated glaucoma caused by different drug categories.</strong></p><figure class="image"><img style="aspect-ratio:716/248;" src="https://cdn.megawecare.com/GHBY/Internal-Images/opthal-fig-2.webp" width="716" height="248"></figure><h2 id="discussions">Discussions</h2><ul><li>Preventing drug-associated glaucoma is crucial.</li><li>Some patients should avoid high-risk drugs.</li><li>Managing diabetes in elderly patients is critical due to future prevalence estimates.</li><li>Regular monitoring is essential for diabetic glaucoma patients, considering potential medication changes for better outcomes.</li><li>Research identified the risk of drug-associated glaucoma with antihypertensive drugs like hydrochlorothiazide and calcium channel blockers. This highlights the importance of monitoring ocular side effects in patients on long-term antihypertensive treatment, particularly for drugs like amlodipine, hydrochlorothiazide, and valsartan.</li><li>Mechanical obstruction and loss of trabecular meshwork can lead to elevated eye pressure with repeated injections. Pre-treatment options can help reduce temporary IOP spikes. Clinicians should be aware of medications that may cause glaucoma and closely monitor patients using such drugs. Regular eye exams are crucial for patients on these medications.</li></ul><h2 id="conclusion">Conclusion</h2><ul><li>Preventing drug-associated glaucoma is more effective than treatment. Identifying the risk and drug-induced times of systemic and ophthalmic drugs can reduce occurrence risk.</li><li>It is essential for clinicians to thoroughly evaluate the risks associated with medications related to glaucoma and modify treatment plans accordingly.</li><li>Clinical practitioners should be vigilant and communicate these risks to the patients.</li></ul>

Opthal Update   Issue 6   Nov 2024

<ul><li><a href="#aim">Aim</a></li><li><a href="#methods">Methods</a></li><li><a href="#assesment-parameters">Assessment parameters</a></li><li><a href="#results">Results</a></li><li><a href="#discussions">Discussions</a></li><li><a href="#conclusion">Conclusion</a></li></ul>