Gabapentin use linked to angle-closure glaucoma
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Acute angle-closure glaucoma may be associated with the use of gabapentin prior to glaucoma diagnosis, according to a study conducted by the University of British Columbia.
The study identified patients enrolled in the PharMetrics Plus database between Jan. 1, 2006, and Dec. 31, 2016. with acute angle-closure glaucoma (AAG), and 14,377 patients who developed AAG were eligible for inclusion in this study.
The use of gabapentin or pregabalin was considered if the patient had received a prescription for either drug in the year before their diagnosis.
“To evaluate the impact of the extent of gabapentin exposure in the year before diagnosis, the association between gabapentin use and the incidence of AAG was assessed for each of limited, moderate and significant exposure,” Mitchell J. Browne, MD, and colleagues wrote.
Results showed that moderate use of gabapentin in patients in the year before diagnosis was proven to be statistically significantly associated with the incidence of AAG. Current use of gabapentin or any drug examined in this study did not show significance with the incidence of AAG.
“To the best of our knowledge, this nested case-control study represents the first cohort to date among which the association of gabapentin or pregabalin use and the incidence of AAG has been investigated,” the authors wrote. “Nonetheless, conclusions as to causal relationships cannot be made based solely on these observations.”
Further research and investigation are required to evaluate these statements, but physicians and patients should be aware of the potential association between gabapentin use and AAG incidence, they concluded. – by Erin T. Welsh
Disclosure: Browne reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Acute angle-closure glaucoma has been getting a lot of press lately, and for good reason. This condition is more common and insidious than previously thought and is more likely to lead to blindness than open-angle glaucoma. Systemic medications such as tricyclic antidepressants, low potency antipsychotics, topiramate and selective serotonin reuptake inhibitors have been associated with AAG. How about gabapentin and pre-gabapentin?
Browne and colleagues, in their nested case-controlled study, indeed find an association between gabapentin use in the year before glaucoma diagnosis and AAG. Interestingly, they found no association between current gabapentin use and AAG. This is an odd finding. If gabapentin use was associated with AAG, why would you only see that association in the year after stopping the drug?
This study does not at all show that gabapentin use causes AAG. Still, it does serve as a good reminder to review systemic health and medications with your patients. Further, utilize gonioscopy (still the gold standard for angle closure screening, sorry OCT) in all patients with angle closure risk factors, be they use of certain medications or narrow anterior chamber angles.
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