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Editors Selection IGR 19-3
Progression / Prognostic Factors: Do calcium channel blockers slow - or worsen -glaucoma progression?
Comment by Sabrina Liu & Louis Pasquale on:
125309 Association of Systemic Calcium Channel Blocker Use with Visual Field Progression in a Large Real-World Cohort from Glaucoma Clinics, Montesano G; Rabiolo A; Garway-Heath DF et al., Ophthalmology. Glaucoma, 2025; 0:
Calcium channel blockers (CCBs) are frequently prescribed for cardiovascular disease, but their effect on glaucoma remains uncertain. Several studies indicate that CCB use is linked to a higher risk of a glaucoma diagnosis,1,2 while others suggest that CCBs have no association or may even have a protective effect on disease progression.3,4 This retrospective longitudinal case-comparison study examined the relationship between CCB use and the rate of visual field (VF) progression.
Data from 14,475 eyes (including 1,942 from CCB users) with at least 5 reliable VFs over a minimum of 4 years—measured using SITA Standard and/or SITA Fast—were analyzed. The median follow-up was 8.6 years for CCB users and 8.2 years for non-users. After one-to-one propensity score matching (PSM) of all CCB users with non-users, linear mixed-effect models (LMMs) estimated the rate of MD progression at -0.31 (95% CI: -0.33 to -0.28) dB/year for CCB users and -0.35 (95% CI: -0.37 to -0.33) dB/year for matched controls, with a P-value of 0.016. Multivariable analyses, including all non-users, corroborated these findings, and all sensitivity analyses supported the results. This study reveals a small but statistically significant association between CCB use and a slower rate of VF deterioration, adding to the ongoing debate about their role in glaucoma.
Key strengths of this study include the large, multi-site sample size across five glaucoma clinics with long-term follow-up, rigorous matching and modelling methods, and multiple sensitivity analyses that support the study conclusions. Key limitations include the lack of information about the duration and dosage of CCB exposure and systemic medications, limited ethnic diversity, and unclear glaucoma diagnostic labels. Eye care providers should be cautious when advising glaucoma patients about CCB use, given the ongoing controversy surrounding their relation to disease onset and progression.
References
- Müskens RP, de Voogd S, Wolfs RC, Witteman JC, Hofman A, de Jong PT, Stricker BH, Jansonius NM. Systemic antihypertensive medication and incident open-angle glaucoma. Ophthalmology. 2007 Dec;114(12):2221-6. doi: 10.1016/j.ophtha.2007.03.047. Epub 2007 Jun 12. PMID: 17568677. https://doi.org/10.1016/j.ophtha.2007.03.047
- Zheng W, Dryja TP, Wei Z, Song D, Tian H, Kahler KH, Khawaja AP. Systemic Medication Associations with Presumed Advanced or Uncontrolled Primary Open-Angle Glaucoma. Ophthalmology. 2018 Jul;125(7):984-993. doi: 10.1016/j.ophtha.2018.01.007. Epub 2018 Feb 9. PMID: 29433851. https://doi.org/10.1016/j.ophtha.2018.01.007
- Koseki N, Araie M, Tomidokoro A, Nagahara M, Hasegawa T, Tamaki Y, Yamamoto S. A placebo-controlled 3-year study of a calcium blocker on visual field and ocular circulation in glaucoma with low-normal pressure. Ophthalmology. 2008 Nov;115(11):2049-57. doi: 10.1016/j.ophtha.2008.05.015. Epub 2008 Jul 31. PMID: 18672290. https://doi.org/10.1016/j.ophtha.2008.05.015
- Koseki N, Araie M, Yamagami J, Shirato S, Yamamoto S. Effects of oral brovincamine on visual field damage in patients with normal-tension glaucoma with low-normal intraocular pressure. J Glaucoma. 1999 Apr;8(2):117-23. PMID: 10209728. https://doi.org/10.1097/00061198-199904000-00006
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