Rogier P.H.M. Müskens

Cholesterol-Lowering Drugs and Incident Open-Angle Glaucoma: A Population-Based Cohort Study

Background Open-angle glaucoma (OAG) is a progressive neurodegenerative disease that may lead to blindness. An elevated intraocular pressure (IOP) is its major risk factor. OAG treatment is currently exclusively directed towards the lowering of the IOP. IOP lowering does not prevent disease progression in all patients and thus other treatment modalities are needed. Earlier studies reported cholesterol-lowering drugs to have neuroprotective properties. The aim of this study was to determine the associations between the use of cholesterol-lowering drugs and incident OAG. Methodology/Principal Findings Participants in a prospective population-based cohort study underwent ophthalmic examinations, including IOP measurements and perimetry, at baseline and follow-up. The use of statins and non-statin cholesterol-lowering drugs was monitored continuously during the study. Associations between the use of cholesterol-lowering drugs and incident OAG were analyzed with Cox regression; associations between cholesterol-lowering drugs and IOP at follow-up were analyzed with multiple linear regression. During a mean follow-up of 9.8 years, 108 of 3939 eligible participants (2.7%) developed OAG. The hazard ratio for statin use was 0.54 (95% confidence interval 0.31–0.96; P = 0.034) and for non-statin cholesterol-lowering drugs 2.07 (0.81–5.33; P = 0.13). The effect of statins was more pronounced with prolonged use (hazard ratio 0.89 [0.41–1.94; P = 0.77] for use two years or less; 0.46 [0.23–0.94; P = 0.033] for use more than two years; P-value for trend 0.10). The analyzes were adjusted for age and gender, baseline IOP and IOP-lowering treatment, the family history of glaucoma, and myopia. There was no effect of statins on the IOP. Conclusions/Significance Long-term use of statins appears to be associated with a reduced risk of OAG. The observed effect was independent of the IOP. These findings are in line with the idea that statins have neuroprotective properties and may open a way to a new OAG treatment modality.

An evaluation of algorithms designed to classify the results from frequency doubling perimetry

All previously published algorithms for the interpretation of frequency doubling perimetry test results were compared in full‐threshold mode in a large group of glaucoma patients (n = 452) and normal subjects (n = 237). Areas under the receiver–operating characteristic (ROC) curve ranged from 0.86 to 0.92. None of the algorithms performed substantially better than simply counting the number of defects p < 1% in the total deviation plot. For this algorithm, we found a sensitivity of 0.90 and a specificity of 0.81 at a cut‐off point of >1 defect, and an area under the ROC curve of 0.92.

Topical β-Blockers and Mortality

PURPOSE To study the associations between long-term and short-term use of topical beta-blockers and mortality. DESIGN Prospective population-based cohort study. PARTICIPANTS To examine long-term effects, 3842 participants aged 55 years and older were recruited. To examine short-term effects, 484 incident beta-blocker users and 4700 age-matched controls were recruited. All participants were recruited as part of the Rotterdam Study. METHODS To examine long-term effects, associations between topical beta-blocker use before and at baseline, between 1990 and 1997, and mortality between 1997 and 2005 were studied. Data were analyzed using Cox regression, and hazard ratios were adjusted for age, gender, smoking, systemic hypertension, diabetes mellitus, and angina pectoris. Short-term effects were defined as death within 3 months after the first prescription of a topical beta-blocker. Mortality was compared between incident beta-blocker users, that is, participants who started using a topical beta-blocker between the onset of the Rotterdam Study in 1990 and October 1, 2004, and age-matched controls. Short-term effects were examined using a chi-square test. Confounding by smoking was analyzed by stratification. MAIN OUTCOME MEASURES For long-term effects, hazard ratios of topical beta-blocker use for all-cause mortality and cardiovascular mortality; for short-term effects, chi-square statistics between mortality of incident topical beta-blocker users and age-matched controls. RESULTS With regard to long-term effects, mean age at baseline was 72 years (standard deviation, 7 years). Topical beta-blockers were used by 228 participants. Seven hundred nine participants died during the follow-up (18%); 135 (3.5%) died of a cardiovascular cause. The hazard ratio of topical beta-blocker use was 0.94 (95% confidence interval [CI], 0.71-1.25; P = 0.69) for all-cause mortality and 1.02 (95% CI, 0.56-1.86; P = 0.95) for cardiovascular mortality. With regard to short-term effects, 4 (0.8%) of the 484 incident topical beta-blocker users died within 3 months after their first prescription; 65 (1.4%; P = 0.31) of the 4700 aged-matched controls died within a similar period. CONCLUSIONS Use of topical beta-blockers seems not to be associated with excess mortality.

Antithrombotic Medication and Incident Open-Angle Glaucoma

PURPOSE To determine the associations between the use of antithrombotic drugs and incident open-angle glaucoma (OAG). METHODS Ophthalmic examinations including measurements of the IOP and perimetry were performed at baseline and follow-up in 3939 participants of the prospective population-based Rotterdam Study who did not have OAG at baseline. The use of antithrombotic drugs was monitored continuously during follow-up. Antithrombotic drugs were stratified into anticoagulants and platelet aggregation inhibitors. Associations between incident OAG and the use of antithrombotic drugs were assessed using Cox regression; the model was adjusted for age, sex, baseline IOP and IOP-lowering treatment, family history of glaucoma, and myopia. Associations between antithrombotic drugs and IOP at follow-up were analyzed with multiple linear regression. RESULTS During a mean follow-up of 9.8 years, 108 participants (2.7%) developed OAG. The hazard ratio for anticoagulant use was 0.90 (95% confidence interval [CI], 0.55-1.48; P = 0.69) and for platelet aggregation inhibitors 0.80 (0.53-1.21; P = 0.28). There was no trend towards a reduced or increased risk of incident OAG with prolonged anticoagulant use (P value for trend 0.84) or platelet aggregation inhibitor use (0.59). There was a significant IOP-lowering effect of anticoagulants (-0.31 mm Hg; 95% CI, -0.58 to -0.04 mm Hg; P = 0.025) but not of platelet aggregation inhibitors (P = 0.06). The IOP-lowering effect of anticoagulants disappeared after additional adjustment for the use of systemic beta-blockers. CONCLUSIONS Use of anticoagulants or platelet aggregation inhibitors appears not to be associated with incident OAG.

Glaucoma drainage device surgery after vitreoretinal surgery : incidence and risk factors

The initial success of vitreoretinal surgery can be annihilated by an acceleration of preexisting glaucoma or the development of secondary glaucoma. Aim of this study was to determine the incidence of and risk factors for medically uncontrollable glaucoma after vitreoretinal surgery.

Glaucoma screening during regular optician visits: the feasibility and specificity of screening in real life

Purpose:  To determine the feasibility and specificity of glaucoma screening during regular optician visits.

High protein S activity due to C4b-binding protein deficiency in a 34-year-old Surinamese female with ischemic retinopathy

In this study, we present the first case of a 34‐year‐old Surinamese female with ischemic retinopathy and increased free protein S due to C4BP deficiency. Possibly, the low PS/C4BP complex level has increased the risk of arterial thrombosis in our patient.

Influence of glaucoma surgery on visual function: a clinical cohort study and meta-analysis

To determine the cost (loss of visual function associated with the procedure) and benefit (long‐term preservation of the visual field) of glaucoma surgery.

CHOLESTEROL-LOWERING DRUGS AND INCIDENT OPEN-ANGLE GLAUCOMA

Purpose To determine the association between the use of statins and non-statin cholesterol-lowering drugs and incident open-angle glaucoma. Methods In a prospective population-based cohort study among 3939 participants aged 55 years and above, ophthalmic examinations including measurement of the intraocular pressure, assessment of the optic nerve head and perimetry were performed at baseline and after an average follow-up duration of 9.8 years. The use of statins and non-statin cholesterol-lowering drugs was monitored continuously during follow-up. Associations between incident glaucomatous visual field loss and the use of statins and non-statin cholesterol-lowering drugs were assessed using cox-regression models adjusted for age, gender, intraocular pressure lowering treatment and potential (mainly cardiovascular) confounders. Results During follow-up, 108 participants (2.7%) developed glaucomatous visual field loss. The HR for statin use was 0.56 (95% CI 0.32 to 0.99; p=0.045) and for non-statin cholesterol lowering drugs 1.82 (0.71 to 4.66; p=0.21). There was a significant trend towards a reduced risk of developing OAG with prolonged statin use (HR 0.89, 95% CI 0.41 to 1.93 for use during 2 years or less; HR 0.44, 95% CI 0.22 to 0.89 for use during more than 2 years). Conclusions Long-term use of statins seems to be associated with a reduced risk of open-angle glaucoma. This result is consistent with an earlier study and suggests that statins should be further explored as a new class of medications for the treatment of glaucoma, especially for those patients in whom disease progression continues despite an apparently sufficient intraocular pressure reduction.