Calcium Channel Blocker Use Linked to Increased Glaucoma Risk

A recent study published in JAMA Ophthalmology by Alan Kastner and colleagues conducted using data from the UK Biobank has raised concerns about the association between the use of calcium channel blockers (CCBs) and an increased risk of glaucoma. This study, which included over 427,000 adult participants, sheds light on the potential link between this common class of medications and eye health.

In this extensive study, a total of 427,480 adults were included, with a median age of 58 years (with an interquartile range of 50 to 63 years). Slightly over half of the participants, accounting for 54.1%, were women. Within the study population, 33,175 individuals, constituting 7.8% of the total, were users of calcium channel blockers (CCBs).

To conduct the respective analyses, participants with complete data for glaucoma status (n = 427,480), intraocular pressure (IOP) measurements (n = 97,100), and optical coherence tomography (OCT)-derived inner retinal layer thicknesses (n = 41,023) were eligible.

After making adjustments for crucial sociodemographic factors, medical history, anthropometric measures, and lifestyle factors, it was revealed that the use of CCBs, but not other antihypertensive medications, was associated with a significantly increased risk of glaucoma. Specifically, the odds ratio (OR) for glaucoma among CCB users was 1.39, with a confidence interval (CI) ranging from 1.14 to 1.69, and a p-value of 0.001.

The study found that the use of calcium channel blockers was linked to thinner inner retinal layer thicknesses, as measured by macular ganglion cell-inner plexiform layer (mGCIPL) and macular retinal nerve fiber layer (mRNFL) thicknesses. The decrease in thickness was approximately 0.34 μm (CI: -0.54 to -0.15 μm; p = 0.001) for mGCIPL and 0.16 μm (CI: -0.30 to -0.02 μm; p = 0.03) for mRNFL.

There was no statistically significant association between the use of calcium channel blockers and intraocular pressure (IOP), with a negligible change of -0.01 mm Hg (CI: -0.09 to 0.07 mm Hg; p = 0.84).

These comprehensive findings underscore a concerning association between CCB usage and glaucoma, along with related structural changes in the inner retinal layers. Importantly, it suggests that this relationship might not be mediated by changes in intraocular pressure, raising the possibility of other mechanisms at play. Although a causal link has yet to be established, these results emphasize the need for further investigation and consideration when prescribing CCBs, especially in patients at risk of glaucoma. Regular eye examinations are crucial for individuals taking CCBs to monitor their eye health and detect potential issues promptly.

Reference:

Kastner, A., Stuart, K. V., Montesano, G., De Moraes, C. G., Kang, J. H., Wiggs, J. L., Pasquale, L. R., Hysi, P., Chua, S. Y. L., Patel, P. J., Foster, P. J., Khaw, P. T., Khawaja, A. P., Allen, N., Aslam, T., Atan, D., Balaskas, K., Barman, S., Barrett, J., … UK Biobank Eye and Vision Consortium. (2023). Calcium channel blocker use and associated glaucoma and related traits among UK Biobank participants. JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2023.3877