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Original Investigation
January 12, 2017

Association of Systemic Medication Use With Intraocular Pressure in a Multiethnic Asian PopulationThe Singapore Epidemiology of Eye Diseases Study

Author Affiliations
  • 1Singapore Eye Research Institute, Singapore National Eye Center, Singapore
  • 2Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
  • 3Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
JAMA Ophthalmol. Published online January 12, 2017. doi:10.1001/jamaophthalmol.2016.5318
Key Points

Question  What is the association of systemic medication with intraocular pressure in a multiethnic Asian population?

Findings  In a post hoc analysis of a population-based study of 8063 participants from 3 ethnic groups (Chinese, Malays, and Indians), lower intraocular pressure was more likely associated with participants using systemic β-blockers, whereas higher intraocular pressure was more likely associated with participants using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, or sulfonylureas.

Meaning  The effect of commonly dispensed systemic medication on intraocular pressure may have implications for glaucoma risk in individuals taking these medications for coexisting comorbidities.


Importance  There is limited understanding of the associations between systemic medication use and intraocular pressure (IOP) in the general population.

Objective  To examine the association between systemic medication use and IOP in a multiethnic Asian population.

Design, Setting, and Participants  In this post hoc analysis of the Singapore Epidemiology of Eye Diseases study, a population-based study of 10 033 participants (78.7% response rate) from 3 racial/ethnic groups (Chinese [recruited from February 9, 2009, through December 19, 2011], Malays [recruited from August 16, 2004, though July 10, 2006], and Indians [recruited from May 21, 2007, through December 29, 2009]), participants with glaucoma, previous ocular surgery, or trauma and an IOP asymmetry greater than 5 mm Hg between eyes were excluded. Intraocular pressure was measured using Goldmann applanation tonometry. An interviewer-administered questionnaire was conducted to collect data on medication and other variables. Data analysis was performed from August 1 through October 31, 2015.

Main Outcomes and Measures  Associations between medication and IOP were assessed using linear regression models adjusted for age, sex, body mass index, ethnicity, and the medical condition for which the medication was taken (angiotensin-converting enzyme inhibitors [ACEIs], angiotensin receptor blockers [ARBs], and β-blockers adjusted for blood pressure, statins adjusted for lipids, and biguanides, sulfonylureas, α-glycosidase inhibitors [AGIs], and insulin adjusted for glycosylated hemoglobin). Medications associated with significant IOP differences were incorporated into regression models adjusted for concomitant use of multiple medications. Generalized estimating equation models were used to account for correlation between eyes.

Results  Of the 10 033 participants, we analyzed 8063 (mean [SD] age, 57.0 [9.6] years; 4107 female [50.9%]; 2680 Chinese [33.2%], 2757 Malay [34.2%], and 2626 Indian [32.6%] individuals). Systemic β-blocker use was independently associated with an IOP of 0.45 mm Hg lower (95% CI, −0.65 to −0.25 mm Hg; P < .001). Conversely, higher mean IOP was associated with use of ACEIs (0.33 mm Hg higher; 95% CI, 0.08 to 0.57 mm Hg; P = .008), ARBs (0.40 mm Hg higher; 95% CI, 0.40-0.75 mm Hg; P = .02), statins (0.21 mm Hg higher; 95% CI, 0.02-0.4 mm Hg; P = .03), and sulfonylureas (0.34 mm Hg higher; 95% CI, 0.05-0.63 mm Hg; P = .02). An interaction between medication classes for additive, synergistic, or antagonistic effects on IOP was not identified.

Conclusions and Relevance  Although systemic β-blocker use was associated with lower IOP and systemic ACEI, ARB, statin, and sulfonylurea use was associated with higher IOP in this study, the associations were modest at best. Only the associations with systemic hypoglycemic agents were greater than 1 mm Hg, a threshold that has translated to a 14% greater risk of incident glaucoma across 5 years in other studies. At this point, the effect of systemic medication on IOP in eyes with glaucoma is not well elucidated but important. Our findings indicate that patients with glaucoma may potentially be at risk of higher or lower IOP, depending on medication class, and this would in turn affect management of IOP control.