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Glaucoma meds may increase risk of nuclear opacities in black population

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STONY BROOK, N.Y. — The use of glaucoma drugs tripled the risk of developing nuclear opacities in black patients in a large population-based cohort study.

Researchers here and at other centers evaluated over a 4-year period 2,609 participants enrolled in the Barbados Eye Studies who had no nuclear opacities at baseline. The relative risk of developing nuclear opacities also increased with age, female gender, darker iris color, myopia, history of diabetes and leaner body mass, all of which show similarities to other populations.

A threefold to fivefold increased relative risk of developing nuclear opacities was found in patients who were using IOP-lowering medication, most commonly beta-blockers. A borderline significant increased relative risk of developing nuclear opacities was also found in patients with an IOP of more than 21 mm Hg.

Of the 2,609 participants, 59 were being treated with IOP-lowering medications for a median duration of 5 years. All had used various combinations of topical medications with no surgical approaches reported at baseline. Eighty percent were taking beta blockers; 47 were on timolol maleate or betaxolol, 31 used pilocarpine, 18 used acetazolamide, 13 used epinephrine, 12 used dipivefrin HCl and four reported using "eye drops."

Of those treated with IOP-lowering medications, 33.9% developed nuclear opacities after 4 years, compared with 7.5% of people with IOPs of 21 mm Hg or less and no treatment. People between the ages of 50 and 59 were 11 times more likely than those in the 40- to 49-year age bracket to develop nuclear opacities, with the risk increasing with age. Women had a nearly twofold increased risk compared with men in developing nuclear opacities.

M. Cristina Leske, MD, MPH, with Stony Brook University here, noted the sample size was small. “The reason for the apparent link between use of topical medications for lowering IOP and the significant increased risk of nuclear cataracts is not clear, and needs to be determined by clinical trials of those medications,” she wrote in the July issue of Ophthalmology.