Risk of glaucoma in elderly patients treated with inhaled corticosteroids for chronic airflow obstruction

Background: Topical and systemic corticosteroids are well known to raise intra-ocular pressure while the effect of inhaled corticosteroids (ICS) on the risk of glaucoma remains uncertain. We sought to determine the risk of new onset ocular hypertension or glaucoma requiring treatment, associated with the use of ICS in elderly patients treated for airways disease. Methods: We carried out a nested case-control study using the databases from the Quebec provincial health insurance plan. A cohort of patients receiving respiratory medications was formed among all subjects 66 years of age and older. Cases were subjects in whom treatment for glaucoma was initiated between January 1, 1988 and December 31, 2003 after a first ever visit to an ophthalmologist within the preceding 90 days. Age-matched controls were selected among individuals who also visited an ophthalmologist for the first time within 90 days of the case's treatment date and did not receive a treatment for glaucoma. Results: A total of 2291 cases were identified. For comparison, a total of 13,445 age-matched controls were selected. The mean age was (75 +/- 4.2 years). The adjusted rate ratio for glaucoma was 1.05 (95% CI 0.91-1.20) with ICS use in the preceding 30 days. There was no dose-related effect of ICS on the risk of glaucoma or raised intra-ocular pressure requiring treatment. Continuous use of high-dose ICS for 3 of more months was not associated with an increased risk of glaucoma. Conclusion: In a large cohort of elderly patients treated for airways disease, we found that current use and continuous use of high-dose ICS did not result in an increased risk of glaucoma or raised intra-ocular pressure requiring treatment. (C) 2009 Elsevier Ltd. All rights reserved.