RISK OF OCULAR HYPERTENSION OR OPEN-ANGLE GLAUCOMA IN ELDERLY PATIENTS ON ORAL GLUCOCORTICOIDS

Background Ocular hypertension and open-angle glaucoma are well-known side-effects of treatment with topical ophthalmic glucocorticoids. The re is uncertainty about the risk of these disorders with oral glucocor ticoid therapy. Methods Data from the Quebec universal health insuranc e programme for the elderly were used to identify 9793 patients with a new diagnosis of ocular hypertension or open-angle glaucoma, or on ne wly prescribed treatment for these disorders (cases). 38 325 controls were randomly selected from ophthalmology patients seen in the same mo nth and year as the case (index date). Current use of oral glucocortic oids was defined as that within 14 days of the index date. All glucoco rticoid doses were converted to the equivalent amount of hydrocortison e. The case-control analysis was done by conditional logistic regressi on and adjusted for age, sex, systemic hypertension, diabetes mellitus , ophthalmic glucocorticoids, glucocorticoid injections, and variables related to general health. Findings The mean ages of cases and contro ls were similar (74.9 [SD 6.3] vs 74.7 [6.4]). The adjusted odds ratio of ocular hypertension or open-angle glaucoma for current users of or al glucocorticoids compared with non-users was 1.41 (95% CI 1.22-1.63) . There was a dose-related increase in the adjusted odds ratios for cu rrent users: 1.26 (1.01-1.56) for less than 40 mg per day of hydrocort isone, 1.37 (1.06-1.76) for patients on 40-79 mg per day, and 1.88 (1. 40-2.53) for patients on 80 mg or more per day. The odds ratios also i ncreased with the duration of treatment over the first 11 months of ex posure. Interpretation The use of oral glucocorticoids increases the r isk of ocular hypertension or open-angle glaucoma in elderly patients. In patients in this age-group who need long-term treatment with high doses of oral glucocorticoids, monitoring of intraocular pressure may be justified.