By Mary Ann Moon  |  Mon, 08 Feb 2010 21:00 GMT
Elsevier Global Medical NewsBreaking NewsPatients with glaucoma who used glaucoma medications were 74% less likely to die during 4 years of follow-up than were glaucoma patients who didn’t use those drugs, according to a report in the February issue of the Archives of Ophthalmology. In a large retrospective study of beneficiaries in a Midwestern managed care network, that mortality benefit was found across several classes of medication, including topical beta-antagonists, alpha-agonists, topical carbonic anhydrase inhibitors (CAIs), oral CAIs, miotics, epinephrine compounds, and prostaglandin analogues, said Dr. Joshua D. Stein and his associates at the University of Michigan, Ann Arbor. Many studies have examined the relationship between glaucoma and mortality, the investigators noted, but few “have considered whether the medications commonly used to treat glaucoma may affect the association.” Some of the topical agents, notably topical beta-blockers, are absorbed systemically and can affect cardiac function, pulmonary function, and systemic blood pressure, the researchers added. They assessed prescription medication use and mortality using the health care network’s database, studying 21,506 patients who were treated for glaucoma or suspected glaucoma between 2003 and 2007. The mean patient age was 60 years, and 55% of the patients were female. Eighty-two percent of the patients were white. Patients often had comorbid conditions, including hypertension (53% of patients), diabetes (41%), hyperlipidemia (36%), and ischemic heart disease (31%). A total of 237 (1.1%) of patients in the group died during the study period. During the study period, 28% of the patients filled prescriptions for glaucoma medications, usually prostaglandin analogues and beta-antagonists. After researchers adjusted for variables such as age, sex, insurance status, and comorbid conditions, the use of any class of glaucoma medication was associated with a 74% reduced hazard of death (adjusted odds ratio 0.26), compared with no use of glaucoma medications, Dr. Stein and his colleagues said (Arch. Ophthalmol. 2010;128:235-40). “This association remained statistically significant for various glaucoma medication classes and for different combinations of glaucoma medications, after adjustment for various demographic and clinical variables and comorbid medical conditions,” the researchers noted. The reasons why the drugs appear to confer a mortality benefit remain unclear. Aside from the known cardiovascular benefits of beta-blockers, “there may be other beneficial systemic effects of topical glaucoma medications that have yet to be appreciated,” the study’s authors added. It also is possible that what appears to be a drug benefit may actually be caused by differences between patients who use the agents and those who do not. Perhaps patients who receive medications are healthier to start with or have better access to health care. Future studies should address that issue, Dr. Stein and his associates suggested. No financial conflicts of interest were reported. Subject Codes: top_stories; ophthalmology; general_primary; gerontology; http://www.imng.com February 08, 2010   04:00 PM EST