Objective:

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.

Sources:

• BMJ Open Ophthalmology