Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma

E. Garbe, J. LeLorier, J. F. Boivin and S. Suissa
Department of Epidemiology and Biostatistics, McGill Pharmacoepidemiology Research Unit, McGill University, Montreal, Quebec, Canada.

OBJECTIVE: To determine whether the use of inhaled and nasal glucocorticoids is associated with an increased risk of ocular hypertension or open-angle glaucoma. DESIGN: Case-control study. SETTING: Quebec universal health insurance program for all elderly (registered in the Regie de l'assurance maladie du Quebec [RAMQ] database). PATIENTS: Enrollees in the RAMQ database aged 66 years and older. The 9793 case patients were ophthalmology patients with a new diagnosis of borderline glaucoma or open-angle glaucoma or were newly started on treatment for ocular hypertension or glaucoma between 1988 and 1994. The 38,325 control patients were randomly selected among noncases with ophthalmologist visits in the same month and year as the case event (index date). MAIN OUTCOME MEASURES: The odds ratio (OR) of ocular hypertension or open-angle glaucoma was determined in patients using inhaled or nasal glucocorticoids relative to nonusers, using conditional logistic regression analysis. The OR was adjusted for age, sex, diabetes mellitus, systemic hypertension, use of ophthalmic and oral glucocorticoids, and characteristics of health care system use in the year before the index date. RESULTS: Overall, current use of inhaled and nasal glucocorticoids was not associated with an increased risk of ocular hypertension or open-angle glaucoma. Current users of high doses of inhaled steroids prescribed regularly for 3 or more months were at an increased risk with an OR of 1.44 (95% confidence interval, 1.01-2.06). CONCLUSION: Prolonged administration of high doses of inhaled glucocorticoids increases the risk of ocular hypertension or open-angle glaucoma. This finding suggests that in these patients intraocular pressure monitoring may be warranted.

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