Editors Selection (IGR: 7-1) | International Glaucoma Review #202

Editors Selection IGR 7-1

Medical treatment: Statins and glaucoma

Comment by Douglas Johnson on:

12532 Effects of cholesterol-lowering statins on the aqueous humor outflow pathway, Song J; Deng PF; Stinnett SS et al., Investigative Ophthalmology and Visual Science, 2005; 46: 2424-2432

Two for the price of one? Do statins prevent the development of glaucoma, as well as lower your cholesterol? The study by Song et al. (657) is a 'bedside to bench' study based on an intriguing

clinical association. Last year, a database study from a Veteran's Hospital found that patients on any cholesterol-lowering agent (statins or non-statins) have a lower chance of developing glaucoma. Because that study was from a computerized list of diagnoses, IOP and clinical details were not known. The protective effect could have been due to vascular perfusion factors, which would explain the non-statin-drug protective effect, or an effect on IOP.

Statins not only decrease synthesis of cholesterol, but have 'spin-off' effects due to decreasing other molecules in the cholesterol synthesis pathway. One such change is in the cytoskeleton, causing cells to change shape. A number of other cytoskeletal acting drugs have been studied in the eye, and many lower IOP;. statins appear to be another in this category.

Using a dose 100x higher than serum levels of patients treated with statins, the study found lovastatin lowered IOP in perfused pig eyes. Of interest, no changes in trabecular cell shape were found in these eyes, despite lovastatin causing a change in the shape of cultured trabecular cells in plastic culture dishes. Both the IOP effect and cultured cell effects were reversible with an inhibitor of lovastatin, indicating that the statin effect is real and not a sign of general toxicity to the cells.

Lovastatin lowers IOP on perfused pig eyes

While many details remain to be clarified (does lovastatin affect IOP? What do clinically-relevant doses do in the lab?), this study is the first step in 'reverse' translational research: attempting to understand the mechanism of a clinical finding by going to the laboratory. This is the heart of science, and an excellent demonstration of the role of the clinician-scientist.

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