Make sure you follow scrupulously this recipe and take your eye drops every day at the prescribed time: it's not only your sight you'll be preserving, it's your own life!

Wouldn't this be a great line to boost patient compliance to glaucoma treatment?

We are far from such radical statements of course. If anything, some ‐ rare ‐ previous studies (including the Blue Mountain Eye Study) have hinted at an increased risk of death associated with topical beta-blockers, a finding that was intriguing enough to trigger an editorial recommending further analysis of such an odd association. This is the task that Stein et al. (534) undertook, by retrospectively data-mining a large de-identified private healthcare claims database in Michigan. Out of 1.4 million patients recorded in the years 2003-2007, approximately 28 thousand had glaucoma or suspected glaucoma. From those, they analyzed a final sample of 21500 patients (after excluding subjects younger than 40 or those that were enrolled for a limited time period) out of whom 237 (1.1%) died during the study period. Their results showed a clear decrease of likelihood of death in patients taking topical PGAs, α -agonists and β -blockers, while no glaucoma medication was associated with an increased death-hazard. After adjusting for various potential confounding factors (such as demographics, insurance mode, glaucoma type, glaucoma surgery and co-morbidities) the use of any-class of topical medication was associated with a 74% reduced hazard of death (adjusted HR, 0.26; p < 0.001). Similar results were found with anti-glaucoma combinations, showing that as the number of prescribed medication classes increased the likelihood of death decreased further. Interestingly, this 'life-saving' effect was not seen in glaucoma suspects, but was stronger in patients with open-angle glaucoma, suggesting that it is not the glaucoma medications per se (acting, e.g., through a systemic beneficial effect) that are at the base of this association, but the actual treatment of glaucoma.

Make sure you follow scrupulously this recipe and take your eye drops every day at the prescribed time: it's not only your sight you'll be preserving, it's your own life! Wouldn't this be a great line to boost patient compliance to glaucoma treatment?

Of course, such a conclusion is far from warranted from the results of a claims database analysis. As the authors correctly acknowledge, using anonymous billing records does not permit to identify patterns of care, nor socio-economic confounding factors. It may well be, for instance, that in patients with severe co-morbidities accounting for a higher likelihood of death, the treatment of a non-life-threatening condition like glaucoma is down-prioritized. Or that patients unable to afford multiple medications will choose to buy drugs for their more debilitating conditions rather than for glaucoma. Still, and in spite of these and other limitations that the authors comment diligently, this study reports a clear beneficial effect of glaucoma medications on likelihood of death, encouraging further investigations to better establish the socio-economic benefits of adequate glaucoma detection and treatment strategies.