Elsevier

Survey of Ophthalmology

Volume 55, Issue 1, January–February 2010, Pages 64-77
Survey of Ophthalmology

Reviews in Medicine
Glaucoma and Systemic Diseases

https://doi.org/10.1016/j.survophthal.2009.03.006Get rights and content

Abstract

Glaucoma management may be extremely challenging, especially in elderly patients who have a variety of systemic diseases and take multiple medications. We obtained a comprehensive medical history in patients with primary open-angle glaucoma to determine which systemic diseases are most prevalent and which systemic medications are most commonly used. We have also reviewed the literature that addresses how these concomitant diseases and medical treatments influence the management of glaucoma. Knowledge of systemic diseases and potential drug interactions, especially between various systemic and glaucoma medications, is important for the safe management of glaucoma patients.

Section snippets

Methods

The records of consecutive patients with POAG at Yale Eye Center were prospectively studied to determine the most common systemic diseases and commonly prescribed systemic medications in this population. Institutional Review Board Committee approval was obtained. The diagnosis of POAG was based on a history of elevated intraocular pressure (IOP), open, normal-appearing anterior chamber angle, and glaucomatous optic neuropathy with associated visual field loss. Demographic data included age,

Results

We studied 180 patients with POAG ranging in age from 36 years to 106 years, with a mean of 73 years. There were 101 women and 79 men; 89 were white, 73 were African-American, 15 were Hispanic, and 3 were Asian. The glaucoma medications used by these patients are shown in Table 1.

The 10 most common systemic diseases in our study group are shown in Table 2. Systemic hypertension was the most prevalent, occurring in 73% of the total population. This was followed by hypercholesterolemia in 47%,

Discussion

In the following discussion, we summarize the recent literature, evaluating associations between various systemic diseases and glaucoma. More importantly, we review how systemic medications may have adverse interactions with glaucoma medications or may adversely or beneficially affect the glaucoma and how glaucoma medications may adversely affect the patient's concomitant systemic disorders.

Conclusion

Co-existing systemic diseases and the medications used to treat them may make management of glaucoma challenging. Although simple measures such as nasolacrimal duct occlusion or eyelid closure can help minimize systemic absorption of topical medications, alterations in metabolism and excretion of systemic medications, especially in elderly patients, may still result in harmful interactions. Knowledge of the systemic diseases that are commonly seen in these patients and the systemic medications

Method of Literature Search

A systematic search of the Medline database using the PubMed Web site from 1970 to 2008 was conducted. All relevant articles related to glaucoma and systemic diseases, glaucoma and systemic medications, glaucoma medications, and glaucoma and systemic medications were reviewed. The reference section of the articles was reviewed for the articles that were missed by the initial Medline search. Only articles written in English were reviewed.

Numerous book chapters from the following textbooks were

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    • This article was presented in part at the World Glaucoma Congress Meeting 2009, Boston, MA, USA, and at the Women in Ophthalmology Annual Meeting 2009, San Diego, CA, USA. The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article. The authors would like to thank Dr. David Boone, Corinne Larsen, Gail Grottole, Ann Leone, and Lori Debroisse for data collection, and Dr. John Emerson for analysis.

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