Systemic β-blockers may have a heterogenous impact on glaucoma patients

The Science behind the Tip

Systemic β-blockers could reach the ciliary body epithelium and are associated with lower intraocular pressure. Thus, the additional administration of topical β-blockers in these patients could be less effective (1). Even though the reduction in blood pressure may reduce the perfusion to the optic nerve and increase the incidence of glaucoma, many studies have found lower odds of glaucoma in patients taking oral β-blockers (2)(3). When dealing with glaucoma patients or suspects taking systemic β -blockers, the ophthalmologist should consider that: untreated IOP could be higher, their suspension could lead to a worsening of the disease, topical administration could be less effective (4).

References

(1) Vergroesen JE, Schuster AK, Stuart KV, Asefa NG, Cougnard-Grégoire A, Delcourt C, Schweitzer C, Barreto P, Coimbra R, Foster PJ, Luben RN, Pfeiffer N, Stingl JV, Kirsten T, Rauscher FG, Wirkner K, Jansonius NM, Arnould L, Creuzot-Garcher CP, Stricker BH, Keskini C, Topouzis F, Bertelsen G, Eggen AE, Bikbov MM, Jonas JB, Klaver CCW, Ramdas WD, Khawaja AP; European Eye Epidemiology Consortium. Association of Systemic Medication Use with Glaucoma and Intraocular Pressure: The European Eye Epidemiology Consortium. Ophthalmology. 2023 Sep;130(9):893-906. doi: 10.1016/j.ophtha.2023.05.001. Epub 2023 May 6. PMID: 37150298. (2) Leung G, Grant A, Garas AN, Li G, Freeman EE. A Systematic Review and Meta-analysis of Systemic Antihypertensive Medications With Intraocular Pressure and Glaucoma. Am J Ophthalmol. 2023 Nov;255:7-17. doi: 10.1016/j.ajo.2023.03.014. Epub 2023 Mar 24. PMID: 36966883. (3) Lee EB, Hu W, Singh K, Wang SY. The Association among Blood Pressure, Blood Pressure Medications, and Glaucoma in a Nationwide Electronic Health Records Database. Ophthalmology. 2022 Mar;129(3):276-284. doi: 10.1016/j.ophtha.2021.10.018. Epub 2021 Oct 22. PMID: 34688700; PMCID: PMC8863625. (4) Khawaja AP, Chan MP, Broadway DC, Garway-Heath DF, Luben R, Yip JL, Hayat S, Wareham NJ, Khaw KT, Foster PJ. Systemic medication and intraocular pressure in a British population: the EPIC-Norfolk Eye Study. Ophthalmology. 2014 Aug;121(8):1501-7. doi: 10.1016/j.ophtha.2014.02.009. Epub 2014 Apr 2. PMID: 24702754; PMCID: PMC4109027.

Contributors: *Dario Romano, MD, Eye Clinic, ASST Santi Paolo e Carlo – San Paolo Hospital, University of Milan, Italy

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