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Ophthalmology conditions and treatments

Session: Poster Session A

(326) Anti-epileptic Drugs Use and the Risk of Glaucoma: A population-Based Cohort Study

Monday, August 26, 2024
8:00 AM – 6:00 PM CEST
Location: Convention Hall II

    Presenting Author(s)

  • Wan-Ju Annabelle LEE, MD, PhD.

    Attending physician
    Department of Ophthalmology, Chi Mei Medical Center
    Tainan, Taiwan (Republic of China)

    • Co-Author(s)

  • Daniel Hsiang-Te Tsai, MClinPharm

    PhD student
    School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    Centre for Neonatal and Paediatric Infection
    Tainan, Taiwan (Republic of China)

  • Edward Chia-Cheng Lai, PhD (he/him/his)

    Professor
    Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Taiwan
    National Cheng Kung University
    Tainan City, Taiwan (Republic of China)

Background: Recent antiepileptic drugs (AEDs), including levetiracetam, lacosamide, topiramate, gabapentin, oxcarbazepine, lamotrigine, and zonisamide, are widely prescribed for epilepsy management but are linked to various eye disorders. Yet, comparative studies on these ocular side effects in a broad patient group remain limited.

Objectives: To evaluate the association between glaucoma risk and AEDs use in Taiwan.

Methods: This study utilized a retrospective cohort design, analyzing data from the Longitudinal Health Insurance Database from 2002 to 2013. We included patients over 20 years old without a glaucoma history who used AEDs and excluded those with prior glaucoma, AED use for less than 90 days, or less than one year of National Health Insurance enrollment to reduce confounding factors. The primary outcome was new-onset glaucoma, identified by ICD-9-CM codes. We conducted a time-to-event analysis from AED initiation to glaucoma diagnosis, censoring data at primary or secondary endpoints, last follow-up, medication change, or new medication addition. Comparative glaucoma risks between AED users and non-users were analyzed using the Cox proportional hazards model.

Results: In our study, we analyzed antiepileptic drug usage among patients, finding 255 on topiramate, 1,347 on carbamazepine, 2,224 on valproic acid, 442 on oxcarbazepine, 305 on levetiracetam, 3,033 on phenytoin, and 189 on lamotrigine. Compared to non-users, hazard ratios and 95% confidence intervals for glaucoma were: topiramate 1.42 (0.69-2.93), carbamazepine 1.08 (0.77-1.52), valproic acid 1.08 (0.79-1.49), oxcarbazepine 1.64 (0.93-2.92), levetiracetam 1.20 (0.44-3.28), phenytoin 0.89 (0.66-1.20), and lamotrigine 1.43 (0.66-3.08). The analysis indicated increased glaucoma risk with topiramate, oxcarbazepine, and lamotrigine.

Conclusions: The use of AEDs may be associated with an increased risk of glaucoma, particularly among users of topiramate, oxcarbazepine, and lamotrigine. To substantiate this hypothesis, further research involving population-based studies with sufficient statistical power is recommended.