To evaluate the likelihood of developing glaucoma-related diagnoses in adult patients with hypertension treated with systemic alpha-2 adrenergic receptor agonists compared to those treated with systemic beta-blockers.
Approach:
Study Design: A multicenter, retrospective cohort study using de-identified electronic health records from the TriNetX Analytics Platform.
Population: Patients aged 40 years or older with hypertension who received at least four prescriptions for systemic alpha-2 agonists or beta-blockers.
Exclusions: Patients with preexisting ocular hypertension or primary open-angle glaucoma, concomitant exposure to the comparator drug, or inadequate ophthalmic follow-up were excluded.
Analysis: Propensity score matching was performed, resulting in 4,152 patients in each treatment group. Adjusted Cox proportional hazards analyses were conducted.
Key Findings:
Systemic alpha-2 agonist use was associated with lower odds of ocular hypertension and primary open-angle glaucoma compared to beta-blocker use.
At 3 years, primary open-angle glaucoma developed in 2% of alpha-2 agonist users versus 3% of beta-blocker users.
At 5 years, the rates were 2% for alpha-2 agonists and 4% for beta-blockers for primary open-angle glaucoma.
Ocular hypertension rates were similar initially but lower among alpha-2 agonist users at 5 years (2% vs. 4%).
Interpretation:
The findings indicate an association between systemic alpha-2 agonist use and reduced risks of glaucoma-related diagnoses.
Limitations:
The observational nature of the study prevents establishing causality.
Residual confounding and confounding by indication may exist despite adjustments.
Lack of detailed ophthalmic measures such as intraocular pressure and visual field testing.
Drug adherence could not be confirmed.
Diagnoses were based on diagnostic codes, limiting generalizability beyond the US health care population.
Conclusion:
The association between systemic alpha-2 agonists and glaucoma risk warrants further investigation.
Analysis of more than 61,000 patients found higher odds of elevated loneliness scores among those reporting blindness and those with diabetic retinopathy, but not among patients with glaucoma or age-related macular degeneration.
