Use of Diuretics and Risk of Acute Angle Closure: A Case-Control Study.

PURPOSE: To examine the possible link between acute angle closure (AAC) with use of diuretics. METHODS: A nested case-control study (NCC) was conducted among a cohort of diuretic users using the PharMetrics Plus database from 2006 to 2020. Cases were identified as the first international classification of diseases 9th and 10th editions (ICD-9/10) code for ACC. For each case, 4 controls were selected and matched to the cases by age and sex using density-based sampling. A conditional logistic regression model was used to compute rate ratios (RRs) adjusted for the drugs topiramate, bupropion, sulphonamide antibiotics, acetazolamide, and sulfasalazine. The RRs for a negative control drug, amlodipine, was also assessed. RESULTS: From the initial cohort of 713 574 diuretics users, 1 553 cases and 6 212 controls were identified. No increase in the risk of AAC with current users of diuretics was found (RR = 1.06, (95% CI: 0.81-1.37) for all diuretics; RR = 0.97, (95% CI: 0.71-1.32) for thiazides; RR = 1.24, (95% CI: 0.90-1.73) for loop diuretics; RR = 0.99, (95% CI: 0.73-1.36) for potassium sparing). CONCLUSION: We found no increase in the risk of acute angle closure with use of diuretics. Future studies are needed to confirm these findings.

Association of Topical Prostaglandin Analogue Use With Risk of Spontaneous Abortion.

Importance: Recent case reports suggest use of topical prostaglandin analogues (PGAs) might increase the risk of spontaneous abortions in pregnant people who take these drugs for intraocular pressure control. However, because these reports are derived mainly from voluntary adverse drug reaction databases, they might be prone to reporting bias. Objective: To examine the risk of spontaneous abortions among pregnant people who take topical PGAs. Design, Setting, and Participants: The PharMetrics Plus database (IQVIA) for health claims in the United States from 2006 to 2020 was used as the data source. The percentage of spontaneous abortions was quantified among patients aged 15 to 45 years who were pregnant and took a topical PGA medication during this period compared with a random sample of people in the database not taking a PGA agent. Main Outcomes and Measures: Diagnosis of a spontaneous abortion was ascertained through procedure codes or codes from the International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Results: A total of 3881 people of reproductive age who were prescribed PGAs and 3881 control participants not taking PGAs were identified. Among the 3881 patients in the PGA cohort, 261 were pregnant and 26 had a spontaneous abortion code. Among the 26 individuals, 12 (4.6%) had a spontaneous abortion code within 90 days of the pregnancy code and had an overlapping prescription for a PGA. Among the 12 individuals, 5 (41.7%) were in the age category 40 to 45 years. In the control group, there were 801 pregnancies, 56 of which led to spontaneous abortions (7%), resulting in an increased risk of 2.4% (95% CI, -0.7% to 5.4%; P = .17). Conclusion and Relevance: The results of this case-series study suggest no association between use of PGAs and risk of spontaneous abortions. Given the nature of this study design and potential for unmeasured confounding factors, these results could be explored further in future epidemiologic studies that can better control for potential confounding variables and more accurately ascertain spontaneous abortions through perinatal databases.

Risk of Ocular Adverse Events Associated With Use of Phosphodiesterase 5 Inhibitors in Men in the US.

Importance: A number of case reports and small epidemiologic studies have quantified the risk of ocular adverse events associated with the use of phosphodiesterase type 5 inhibitors (PDE5Is). However, results have been conflicting, and epidemiologic data on the risk of serous retinal detachment (SRD) and retinal vascular occlusion (RVO) are not available. Objective: To quantify the risk of SRD, RVO, and ischemic optic neuropathy (ION) associated with the use of PDE5Is. Design, Setting, and Participants: This cohort study with a nested case-control analysis was performed using data obtained from the PharMetrics Plus database (IQVIA) from January 1, 2006, to December 31, 2020. Cohort members were followed up until the first diagnosis of SRD, RVO, or ION or termination of insurance coverage. For each case, 4 controls were matched by age and time of study entry using density-based sampling. Risk for regular users of PDE5Is was compared with that for nonusers, adjusting for potential confounding variables. Cases with diagnoses of SRD, RVO, and ION in the year before the cohort were excluded. Main Outcomes and Measures: First diagnosis of SRD, RVO, or ION identified by International Classification of Diseases, Ninth Revision or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Adjusted incidence rate ratios (IRRs) with 95% CIs were calculated using conditional logistic regression, controlling for hypertension, coronary artery disease, smoking, and diabetes (for all 3 outcomes) as well as sleep apnea for the ION outcome. Results: The cohort consisted of 213 033 men receiving PDE5Is, including sildenafil, tadalafil, vardenafil, and avanafil. The case-control analysis included a total of 1146 cases of SRD (278), RVO (628), and ION (240) and 4584 controls, and the mean (SD) age in both groups was 64.6 (13.3) years. Patients with SRD, RVO, and ION were more likely to have hypertension, diabetes, coronary artery disease, and sleep apnea. The adjusted IRR for the composite end points of any of the 3 outcomes was 1.85 (95% CI, 1.41-2.42; incidence, 15.5 cases per 10 000 person-years). The adjusted IRR for SRD, RVO, and ION as individual outcomes was 2.58 (95% CI, 1.55-4.30; incidence, 3.8 cases per 10 000 person-years), 1.44 (95% CI, 0.98-2.12; incidence, 8.5 cases per 10 000 person-years), and 2.02 (95% CI, 1.14-3.58; incidence, 3.2 cases per 10 000 person-years), respectively. Conclusions and Relevance: Findings of this cohort study suggest that regular users of PDE5Is might have an increased risk for SRD, RVO, and ION. Regular users of PDE5Is need to be cognizant of ocular adverse events associated with these drugs and alert their physicians if they experience any visual deficits.

Association of Gabapentin or Pregabalin Use and Incidence of Acute Angle-closure Glaucoma.

PRECIS: Gabapentin and its derivatives have numerous indications and are commonly prescribed medications. In this article, we provide evidence of a link between gabapentinoid use and incidence of acute angle-closure glaucoma. PURPOSE: Gabapentinoids, such as gabapentin and pregabalin, are commonly prescribed classes of drugs in North America. We sought to determine the association of gabapentin or pregabalin use and the incidence of acute angle-closure glaucoma. MATERIALS AND METHODS: This was a nested case-control study. All adult patients who developed acute angle-closure glaucoma between January 1, 2006 and December 31, 2016, and enrolled in the PharMetrics Plus database were eligible for inclusion. A conditional logistic regression model was constructed to assess the association between gabapentin or pregabalin use and the incidence of acute angle-closure glaucoma. RESULTS: Incidence of acute angle-closure glaucoma was found to be statistically significantly associated with the use of gabapentin in the year before diagnosis [relative risk (RR), 1.42; 95% confidence interval (CI), 1.00-2.00]. This association was not observed to be statistically significant with the current use of gabapentin (RR, 1.28; 95% CI, 0.77-2.12). Incidence of acute angle-closure glaucoma (AAG) was not found to be statistically significantly associated with either use of pregabalin in the year before diagnosis or current use (RR, 1.00; 95% CI, 0.51-1.93 and RR, 1.50; 95% CI, 0.66-3.38, respectively). CONCLUSIONS: To the best of our knowledge this is the first study to investigate the association between gabapentin or pregabalin use and the incidence of AAG. Gabapentin use in the year before diagnosis was found to be associated with the incidence of AAG.

Association of Postoperative Topical Prostaglandin Analog or Beta-Blocker Use and Incidence of Pseudophakic Cystoid Macular Edema.

PURPOSE: The purpose of this article is to determine the association of postoperative topical prostaglandin analog (PGA) or topical beta-blocker use and the incidence of pseudophakic cystoid macular edema (CME). METHODS: This was a nested case-control study. All adult patients who underwent cataract surgery between January 1, 2006 and December 31, 2016 and who were enrolled in the PharMetrics Plus database were eligible for inclusion. The association between postoperative topical PGAs (bimatoprost, latanoprost, and travoprost/travoprost-z) or beta-blocker (betaxolol, levobunolol, and timolol) use and the incidence of pseudophakic CME was assessed by conditional logistic regression. RESULTS: Five hundred eight cases and 5080 controls were included in the analyses. Incidence of pseudophakic CME was found to be statistically significantly associated with the current postoperative use of both topical PGAs [relative risk (RR), 1.86; 95% confidence interval (CI), 1.04-3.32] and topical beta-blockers (RR, 2.64; 95% CI, 1.08-6.49). Postoperative use of each of bimatoprost (RR, 2.73; 95% CI, 1.35%-5.53%) and travoprost/travoprost-z (RR, 3.16; 95% CI, 1.42-7.03) in the year before diagnosis was demonstrated to be statistically significantly associated with the incidence of pseudophakic CME. This association was not observed to be statistically significant with the postoperative use of latanoprost (RR, 1.55; 95% CI, 0.84-2.88). CONCLUSIONS: To the best of our knowledge this is the largest study that has investigated the association between postoperative topical PGA or topical beta-blocker use and the incidence of pseudophakic CME. Postoperative use of both topical PGAs and topical beta-blockers was found to be associated with the incidence of pseudophakic CME.

Normal tension glaucoma management: a survey of contemporary practice.

OBJECTIVE: The aim of this study was to investigate contemporary practice patterns with respect to normal tension glaucoma (NTG) management and to determine whether the 2 largest NTG trials have influenced ophthalmologists' clinical practice. METHODS: A survey questionnaire was sent to ophthalmologists via the American Glaucoma Society, the Canadian Glaucoma Society, and the Canadian Ophthalmological Society. The questionnaire was designed to investigate ophthalmologists' usual practice with respect to NTG and the extent to which practice has been influenced by the Collaborative Normal Tension Glaucoma Study (CNTGS) and the Low pressure Glaucoma Treatment Study (LoGTS). RESULTS: In total, 419 ophthalmologists completed the survey. Of these, 264 respondents were glaucoma subspecialists. The survey showed that 95% and 64% of ophthalmologists were familiar with the CNTGS and the LoGTS, respectively. Of the respondents, 70% indicated that they would initiate treatment in mild-to-moderate NTG without waiting for documented disease progression. Of the respondents, 61% of the total surveyed and 50% of the glaucoma subspecialists felt that the LoGTS results had no impact on their usual clinical practice. The first-choice topical drug for NTG was a prostaglandin analogue (88% of respondents) or brimonidine (10% of respondents). CONCLUSIONS: Most ophthalmologists treat NTG more aggressively than recommended by the CTNGS protocol. Most ophthalmologists felt that the LoGTS results had no impact on their normal clinical practice. The prostaglandin analogues are, by far, the most popular choice of drug for contemporary management of NTG.

Association of Repeated Intravitreous Bevacizumab Injections With Risk for Glaucoma Surgery.

Importance: Intravitreous injections of anti-vascular endothelial growth factor (VEGF) agents are associated with a sustained increase in intraocular pressure. This sustained elevated intraocular pressure could lead to higher rates of glaucoma surgery to lower this pressure. Objective: To determine the risk of glaucoma surgery following repeated intravitreous bevacizumab injections. Design, Setting, Participants: This nested, case-control study acquired and analyzed data from large, population-based, linked health databases supported by the British Columbia Ministry of Health in Canada. Study participants included all patients with ophthalmic issues in British Columbia, such as those of the Provincial Retinal Diseases Treatment Program, who had received intravitreous bevacizumab injections for exudative age-related macular degeneration between January 1, 2009, and December 31, 2013. Cases were identified using glaucoma surgical codes for trabeculectomy, complicated trabeculectomy, glaucoma drainage device, and cycloablative procedure. For each case, 10 controls were identified and matched for age, preexisting glaucoma, calendar time, and follow-up time. The number of intravitreous bevacizumab injections received per year-3 or fewer, 4 to 6, or 7 or more-was determined for both cases and controls. Data analysis was performed from February 23, 2016, to November 14, 2016. Main Outcomes and Measures: Risk of glaucoma surgery compared with the number of intravitreous bevacizumab injections per year in cases and controls. Rate ratios were adjusted for covariates (diabetes mellitus, myocardial infarction, stroke, and verteporfin use). Results: Seventy-four cases of glaucoma surgery and 740 controls were identified, with a mean (SD) age of 81.3 (8.4) years for cases and 81.4 (7.9) for controls. The case group had more males than the control group (38 [51.4%] vs 272 [36.8%]). The adjusted rate ratio of glaucoma surgery among those who received 7 or more injections per year was 2.48 (95% CI, 1.25-4.93). There was a 10.3% higher number of 7 or more injections among cases compared with controls. The adjusted rate ratio for those who received 4 to 6 injections per year compared with those who received 3 or fewer was 1.65% (95% CI, 0.84-3.23). Conclusions and Relevance: Findings from this large, pharmacoepidemiologic study suggest that 7 or more intravitreous injections of bevacizumab annually is associated with a higher risk of glaucoma surgery and that 4 to 6 injections per year show a nonstatistically significant rate ratio in the same direction.

Correlation in Severity Between Glaucoma and Erectile Dysfunction.

PURPOSE: To examine the association between open-angle glaucoma and erectile dysfunction (ED), and investigate the correlation in severity between these 2 conditions. METHODS: Cross-sectional study with patient questionnaire and retrospective chart review. A total of 167 male patients over 40 years of age who attended ophthalmology clinic visits in Vancouver, British Columbia, Canada, participated in the study by providing written consent and responding to the survey. Patients with previous radiation or surgical prostate treatment were excluded, leaving final sample sizes of 61 glaucoma patients and 67 control patients. Presence and severity of ED was determined using a validated patient questionnaire (the International Index of Erectile Function questionnaire). Presence of glaucoma was based on previous clinical diagnosis, and severity was graded based on visual field index using a 30-2 visual field test with the SITA Standard protocol. Bivariate analysis examined the presence of ED in glaucoma patients versus controls. Risk factors including dyslipidemia, diabetes, hypertension, and smoking were adjusted for using multiple logistic regression. The association between glaucoma and ED severity was assessed with correlation and scatterplot analysis. RESULTS: Glaucoma was found to be a significant risk factor for ED in our population, with an odds ratio of 2.58 (95% confidence interval, 1.15-5.83). Severity of glaucoma and ED were significantly correlated (r=0.365, P=0.007). CONCLUSIONS: Our results demonstrate that there is a positive association between the presence of ED and the diagnosis of glaucoma and a positive association between the severity of ED and the severity of glaucoma.

Neuroretinal Rim Area Change in Glaucoma Patients With Visual Field Progression Endpoints and Intraocular Pressure Reduction. The Canadian Glaucoma Study: 4.

PURPOSE: To compare rim area rates in patients with and without the visual field (VF) progression endpoint in the Canadian Glaucoma Study and determine whether intraocular pressure (IOP) reduction following the endpoint altered rim area rate. DESIGN: Prospective multicenter cohort study. METHODS: setting: University hospitals. PATIENT POPULATION: Two hundred and six patients with open-angle glaucoma were examined at 4-month intervals with standard automated perimetry and confocal scanning laser tomography. INTERVENTION: After the endpoint, IOP was reduced by ≥20%. OUTCOME MEASURES: Univariate analysis for change in rim area rate and multivariable analysis to adjust for independent covariates (eg, age, sex, and IOP). RESULTS: Patients with an endpoint (n = 59) had a worse rim area rate prior to the endpoint compared to those without (n = 147; median [interquartile range]: -14 [-32, 11] × 10(-3) mm(2)/y and -5 [-14, 5] × 10(-3) mm(2)/y, respectively, P = .02). In univariate analysis, there was no difference in rim area rate before and after the endpoint (median difference [95% CI], 8 (-10, 24) × 10(-3) mm(2)/y), but the muItivariate analysis showed that IOP reduction >2 mm Hg after the endpoint was strongly linked to a reduction in rim area rate decline (8 × 10(-3) mm(2)/y for each additional 1 mm Hg reduction). CONCLUSIONS: Patients with a VF endpoint had a median rim area rate that was nearly 3 times worse than those without an endpoint. Lower mean follow-up IOP was independently associated with a slower decline in rim area.

Risk of angle-closure glaucoma with bupropion and topiramate.

IMPORTANCE: Epidemiologic studies have shown that antidepressants may increase the risk of angle-closure glaucoma. We examined the risk of angle-closure glaucoma with bupropion hydrochloride, a unique, popular antidepressant also marketed as a smoking cessation aid. OBSERVATIONS: A nested case-control study was conducted using a large health claims database in the United States from January 1, 2006, to March 31, 2014. The database contained deidentified information pertaining to a cohort of 6 110 723 patients. Cases were defined according to the first coding for angle-closure glaucoma. For each case, 10 control participants were selected and matched to the cases using density-based sampling. Adjusted rate ratios were computed for bupropion, topiramate (positive control group drug), and esomeprazole (negative control group drug). The adjusted rate ratio was 1.09 (95% CI, 0.75-1.59) for bupropion and 2.59 (95% CI, 1.56-4.30) for topiramate. In a prespecified analysis of patients younger than 50 years, the adjusted rate ratio was 1.98 (95% CI, 1.02-3.84) for bupropion and 5.30 (95% CI, 2.54-11.04) for topiramate. CONCLUSIONS AND RELEVANCE: Both bupropion and topiramate are widely prescribed drugs. The risk of angle-closure glaucoma in patients younger than 50 years was twice as high in patients taking bupropion and more than 5 times higher in patients taking topiramate.

Risk for uveitis with oral moxifloxacin: a comparative safety study.

IMPORTANCE: Numerous case reports have suggested that the recent use of moxifloxacin may lead to uveitis. This epidemiologic study is, to our knowledge, the first to explore the relationship between oral moxifloxacin hydrochloride use and uveitis. OBSERVATIONS: We conducted a case-control study within a cohort of men aged 40 to 85 years followed up from January 2001 through December 2011. All cases with a new diagnosis of uveitis were identified. For each case, 10 control subjects were matched by age, cohort entry date, and follow-up duration. For identified uveitis cases, current use of moxifloxacin, levofloxacin, or ciprofloxacin hydrochloride was compared with nonuse. Rate ratios were adjusted for potential confounding variables. We identified 13,313 uveitis cases and 133,130 corresponding controls. Compared with nonusers of fluoroquinolones, current first-time users of moxifloxacin demonstrated the highest risk for uveitis (adjusted rate ratio, 2.98 [95% CI, 1.80-4.94]). Current first-time users of ciprofloxacin (adjusted rate ratio, 1.96 [95% CI, 1.56-2.47]) showed an increased risk for uveitis, while current first-time users of levofloxacin (adjusted rate ratio, 1.26 [95% CI, 0.90-1.77]) did not show a significant association with uveitis. CONCLUSION AND RELEVANCE: Current use of moxifloxacin or ciprofloxacin appears to increase the risk for uveitis. A statistically significant association of current first-time use of levofloxacin with uveitis could not be identified. Levofloxacin may pose the least risk for uveitis compared with moxifloxacin and ciprofloxacin.

Association between phosphodiesterase-5 inhibitors and nonarteritic anterior ischemic optic neuropathy.

BACKGROUND: Use of phosphodiesterase-5 (PDE-5) inhibitors has been reported to be a risk factor for development of nonarteritic anterior ischemic optic neuropathy (NAION) in males, based largely on a number of case reports. The objective of our study was to determine whether men who use this class of medications are more likely than a matched control group to develop NAION. METHODS: A pharmacoepidemiological nested case-control study was used to examine the above association in a health claims database of physician diagnoses and prescription medication dispensing. Cases of NAION were matched with corresponding controls and correlated with the use of PDE-5 inhibitors. A conditional logistic regression model was used to estimate rate ratios for development of NAION with use of PDE-5 inhibitors. RESULTS: A total of 1,109 cases of NAION were found and matched to 1,237,290 controls identified within the database. Cases were more likely to have hyperlipidemia, diabetes, hypertension, myocardial infarction, and cerebrovascular accident in the year preceding their NAION. The adjusted rate ratio for any use of PDE-5 inhibitor in the year before the NAION was 1.01 (95% confidence interval [CI], 0.79-1.28); recent use of a PDE-5 inhibitor in the 30 days before the NAION also had no significant association, with an adjusted rate ratio of 0.96 (95% CI, 0.75-1.23). Results for individual PDE-5 inhibitors did not achieve statistical significance. CONCLUSIONS: Our results do not suggest any association between having a prescription filled for PDE-5 inhibitor medication and receiving a diagnosis code for NAION. This is consistent with other studies in the literature that have failed to elucidate a plausible mechanism by which these drugs might compromise circulation at the optic nerve head.

Association between glaucoma, glaucoma therapies, and erectile dysfunction.

PURPOSE: To examine the association between (1) glaucoma and erectile dysfunction (ED) and (2) topical ß-blocker (BB) use and ED. METHODS: A comprehensive, province-wide database of physician visits and diagnoses and prescription drug dispensing was used to identify cases of ED (1380) and find corresponding controls (13,800). A conditional logistic regression model was used to estimate rate ratios for 2 main exposures: (1) diagnosis of glaucoma and (2) use of a prescription of a topical BB before the index date. A variety of risk factors were adjusted for. RESULTS: Cases were more likely to have coronary artery disease, chronic obstructive pulmonary disease, and diabetes. A crude rate ratio of the current diagnosis of ED in a population with at least 2 separate diagnoses of glaucoma was 1.34 and when adjusted for a number of variables (including oral BB use), this ratio was 1.37 [95% confidence interval (CI), 1.06-1.76]. Use of topical BB in the 30 days before the diagnosis of ED did not have a significant association with a diagnosis of ED, with crude and adjusted rate ratios of 1.05 and 1.10, respectively (95% CI, 0.61-1.99). Topical ocular prostaglandin use was also not associated with ED, with crude and adjusted rate ratios of 0.96 and 0.93, respectively (95% CI, 0.57-1.53). CONCLUSIONS: Our results confirmed an association between ED and glaucoma that cannot be attributed to topical BB use. Given that most cardiovascular and metabolic risk factors were adjusted for, further research in this area will be necessary to elucidate the nature of this association and potential causation.

Statin use and risk for cataract: a nested case-control study of 2 populations in Canada and the United States.

BACKGROUND: In current literature the association between statin use and cataracts is inconsistent and controversial. We sought to further examine the effect of statin use on the risk of cataract and need for surgical intervention in 2 North American populations. METHODS: This retrospective nested case-control study derived data from the British Columbia (BC) Ministry of Health databases from 2000-2007 and the IMS LifeLink database from 2001-2011 to form 2 patient cohorts. The BC cohort was comprised of female and male patients; 162,501 patients were matched with 650,004 control subjects. The IMS LifeLink cohort was comprised of male patients aged 40-85 years; 45,065 patients were matched with 450,650 control subjects. Patients with statin use for > 1 year before the initial ophthalmology visit were identified. Diagnosis and surgical management of cataract were followed. Conditional logistic regression models were used to analyze data. RESULTS: For the BC cohort, the crude rate ratio (RR) for use of any statin was 1.30, and the adjusted RR was 1.27 (95% confidence interval, 1.24-1.30). The adjusted RRs for each individual statin were all statistically significant. For the IMS LifeLink cohort, the crude RR for use of any statin was 1.13, and the adjusted RR was 1.07 (95% confidence interval, 1.04-1.10). CONCLUSIONS: This study demonstrates that statin use is significantly associated with cataract requiring surgical intervention. This relationship was consistent in both North American cohorts. Further assessment of this relationship is recommended, especially because of increased statin use and the importance of acceptable vision in old age when cardiovascular disease is common.

Oral fluoroquinolones and risk of glaucoma.

OBJECTIVE: To evaluate the risk of developing glaucoma in patients taking systemic fluoroquinolones. METHODS: A case-control study was carried out among a cohort of subjects who had visited an ophthalmologist in the Province of British Columbia, Canada from 2000 to 2007. Cases were identified as those newly diagnosed with glaucoma (ICD-9 360). For each case, 5 controls were selected and matched to the cases by age and calendar time. Crude and adjusted rate ratios (RRs) for current, recent, past, and distant use of fluoroquinolones were calculated. RESULTS: From the cohort of 989,591 subjects, 178,264 subjects were diagnosed with glaucoma and 891,320 were corresponding controls. The 2 groups had same average age of 65 and comparable systemic comorbidities including hypertension, coronary artery disease, and diabetes. There was no statistically significant association between the use of systemic fluoroquinolones and the development of glaucoma for current use [RR=1.01 (95% confidence interval (CI), 0.95-1.07)], recent use [RR=1.00 (95% CI, 0.92-1.08)], or past use [RR=0.94 (95% CI, 0.90-1.00)]. Distant use of systemic fluoroquinolones had a small statistically significant increased risk of developing glaucoma [RR=1.12 (95% CI, 1.09-1.14)]. CONCLUSIONS: There was no detected increased association of the development of glaucoma with current, recent, or past use of systemic fluoroquinolone but a minimal statistically significant increased risk was associated with distant use. Future studies should further examine a potential delayed response with fluoroquinolones and glaucoma.

The association between cataract surgery and atypical antipsychotic use: a nested case-control study.

PURPOSE: To investigate cataract risk associated with the use of atypical antipsychotics. DESIGN: Retrospective, nested case-control study. METHODS: A large health claims database (The British Columbia Ministry of Health Databases) from British Columbia, Canada, was used from January 2000 through December 2007. Cases were defined as clinically significant cataracts requiring surgery and were identified using cataract surgery procedure codes. For each case, 4 to 10 controls were selected randomly using a density-based sampling approach and were matched to cases by age and calendar time. Rate ratios were calculated for users of atypical and typical antipsychotics adjusting for known cataractogenic factors. RESULTS: One hundred sixty-two thousand five hundred one cases of cataract surgery and 650 004 controls were included. The adjusted rate ratio for current users of atypical antipsychotics was 0.84 (95% confidence interval, 0.80 to 0.89) compared with nonusers. A greater number of prescriptions filled in the year before cataract surgery compared with the median number of filled prescriptions was associated with a lower cataract surgery rate (adjusted rate ratio, 0.70; 95% confidence interval, 0.65 to 0.75) than those with fewer prescriptions filled (adjusted rate ratio, 0.85; 95% confidence interval, 0.79 to 0.91). CONCLUSIONS: A protective association between the use of atypical antipsychotics and risk of clinically significant cataracts requiring surgery was established. Potential biochemical and neurochemical mechanisms for this protective effect are discussed.

Combination therapy as initial treatment in glaucoma and suspected glaucoma.

OBJECTIVE: We hypothesize that there may be an inappropriate overuse of initial combination therapy in patients with glaucoma and in those who are glaucoma suspects. To test this hypothesis, we examined the British Columbia Population DataBase to determine the frequency of prescription of combination eye drops as initial therapy in glaucoma patients or glaucoma suspects. DESIGN: Cohort study. PARTICIPANTS: The study cohort included all those who visited an ophthalmologist's office between 2004 and 2007. Within the cohort we identified all those who were newly prescribed any ocular hypotensive eye drop. Specifically, we identified those who had been newly prescribed any ocular hypotensive eye drop within 60 days of receiving diagnoses of glaucoma, as defined by having received an international classification for disease code ICD-9 for glaucoma 365. METHODS: We used the Population Data British Columbia (POP Data BC) as the main data source for this study. POP Data BC is a provincially linkable database that captures the physician visits (including inpatient procedures); hospital admissions; demographics; and prescription drug use of 4.5 million residents of British Columbia. RESULTS: Between 2004 and 2007, the percentage of combination therapy as the first ocular hypotensive prescription rose from 12.29% to 18.63%. CONCLUSIONS: The high percentage of combination therapy as initial therapy suggests that ophthalmologists either require additional education in principles of pharmacologic therapy or are unduly influenced by their interaction with the pharmaceutical industry.