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Editors Selection IGR 10-4

Neuroprotection: NSAIDs and latanoprost

Comment by Thierry Zeyen on:

13518 Associations between elevated intraocular pressure and glaucoma, use of glaucoma medications, and 5-year incident cataract: the Blue Mountains Eye Study, Chandrasekaran S; Cumming RG; Rochtchina E et al., Ophthalmology, 2006; 113: 417-424

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Chandrasekaran et al. (1) followed-up 2335 patients participating in the Australian Blue Mountains Eye Study for 5 years, to determine whether baseline elevated IOP, open-angle glaucoma, or glaucoma medications could be an independent risk factor for incident cataract. Conversely, the authors looked if clinically significant cataract at baseline was an independent risk factor for the development of elevated IOP. The five-year incidence of nuclear cataract was 23.4%. The authors found that elevated IOP at baseline increased the risk by two-fold to develop nuclear cataract in patients using glaucoma medications. A marginally significant association was found between the use of glaucoma medications (beta-blockers, miotics, and dipivefrin) and incident nuclear cataract. The authors postulate that glaucoma medications may exacerbate cataractogenic structural changes induced by elevated IOP. On the other hand there was no significant relationship between nuclear cataract at baseline and elevated IOP after five years.

Patients with elevated IOP treated with glaucoma medications have a two-fold increased risk to develop nuclear cataract

The strengths of this study are the high participation rate, careful measurement of study variables using standardized protocols, and masked photo grading scores. Underestimation of the true incident cataract rate, since 25% of the cohort was lost to follow-up, is a limitation of the study. Further, comparison between eyes developing incident nuclear cataract and eyes without any nuclear cataract at baseline was not possible. Because of a random camera fault, around one third of the baseline photographs were not able to be reliably graded, potentially reducing statistical power. The authors did not include ALT as an independent variable; a comparison with the Early Manifest Glaucoma Trial, where an increase in nuclear cataract in the treated group was also found, is therefore not possible. This informative article shows that patients with elevated IOP treated with glaucoma medications had a two-fold increased risk to develop nuclear cataract after five years, after adjusting for age and other confounders.

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