Topical Beta-Blockers and Cardiovascular Mortality: Systematic Review and Meta-Analysis with Data from the EPIC-Norfolk Cohort Study

How latanoprost changed glaucoma management

Glaucoma is currently considered one of the leading causes of severe visual impairment and blindness worldwide. Topical medical therapy represents the treatment of choice for many glaucoma patients. Introduction of latanoprost, 25 years ago, with an entirely new mechanism of action from that of the antiglaucoma drugs used up to that time was a very important milestone. Since then, due mainly to their efficacy, limited systemic side effects and once daily dosing, prostaglandin analogues (PGAs) have become as the first-choice treatment for primary open-angle glaucoma. PGAs are in general terms well tolerated, although they are associated with several mild to moderate ocular and periocular adverse events. Among them, conjunctival hyperemia, eyelash changes, eyelid pigmentation, iris pigmentation and hypertrichosis around the eyes are the most prevalent. The objective of this paper is to review the role of PGAs in the treatment of glaucoma over the 25 years since the launch of Latanoprost and their impact on clinical practice outcomes.

Topical Medication Therapy for Glaucoma and Ocular Hypertension

Glaucoma is one of the most common causes of blindness, thus seriously affecting people’s health and quality of life. The topical medical therapy is as the first line treatment in the management of glaucoma since it is inexpensive, convenient, effective, and safe. This review summarizes and compares extensive clinical trials on the topical medications for the treatment of glaucoma, including topical monotherapy agents, topical fixed-combination agents, topical non-fixed combination agents, and their composition, mechanism of action, efficacy, and adverse effects, which will provide reference for optimal choice of clinical medication. Fixed-combination therapeutics offer greater efficacy, reliable security, clinical compliance, and tolerance than non-fixed combination agents and monotherapy agents, which will become a prefer option for the treatment of glaucoma. Meanwhile, we also discuss new trends in the field of new fixed combinations of medications, which may better control IOP and treat glaucoma.

Association between topical beta-blockers and risks of cardiovascular and respiratory disease in patients with glaucoma: a retrospective cohort study

OBJECTIVE

To determine if topical beta-blocker use is associated with increased risks of cardiovascular and respiratory diseases in patients with glaucoma.

SETTING

A retrospective cohort analysis was conducted using the database from Taiwan's National Health Insurance programme.

PARTICIPANTS

In total, 12 336 newly diagnosed patients with glaucoma from January 2000 to December 2010 were included. The patients with glaucoma were subdivided into two cohorts according to whether they used topical beta-blockers or combination drugs (BBCDs).

PRIMARY OUTCOME MEASURES

The study endpoints included pneumonia, acute respiratory failure, stroke and coronary artery disease (CAD). Univariable and multivariable Cox proportional hazards regression models were used to estimate HRs and 95% CIs for the endpoints of both cohorts.

RESULTS

The BBCD cohort had a slightly higher risk of acute respiratory failure (adjusted HRs=1.16, 95% CI 1.00 to 1.34) and lower risk of CAD (aHR=0.93, 95% CI 0.87 to 0.99) than the non-BBCD cohort. Additionally, the risk of stroke was significantly higher in BBCD cohort than in the non-BBCD cohort (aHR=1.39, 95% CI 1.23 to 1.58), especially the ischaemic stroke (aHR=1.44, 95% CI 1.26 to 1.64; aHR=1.44, 98.75% CI 1.21 to 1.71). After considering the multiplicative interaction of age and sex, the BBCD cohort do not have higher risk of all outcomes than the non-BBCD cohort. Further time-dependent regression analysis revealed BBCD cohort had higher risk of acute respiratory failure (aHR=1.17, 95% CI 1.01 to 1.35) and ischaemic stroke (aHR=1.44, 95% CI 1.26 to 1.65) than non-BBCD cohort. However, after considering the multiplicative interaction of age and sex, the BBCD cohort had no significantly higher risk of all outcomes than the non-BBCD cohort.

CONCLUSION

Topical beta-blocker is not associated with increased risks of cardiovascular and respiratory diseases in patients with glaucoma.