Systemic medication and intraocular pressure in a british population: The EPIC-Norfolk Eye study

Anthony P. Khawaja*, Michelle P.Y. Chan, David C. Broadway, David F. Garway-Heath, Robert Luben, Jennifer L.Y. Yip, Shabina Hayat, Nicholas J. Wareham, Kay Tee Khaw, Paul J. Foster

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

45 Citations (Scopus)


Objective To determine the association between systemic medication use and intraocular pressure (IOP) in a population of older British men and women. Design Population-based, cross-sectional study. Participants We included 7093 participants from the European Prospective Investigation into Cancer-Norfolk Eye Study. Exclusion criteria were a history of glaucoma therapy (medical, laser, or surgical), IOP asymmetry between eyes of >5 mmHg, and missing data for any covariables. The mean age of participants was 68 years (range, 48-92) and 56% were women. Methods We measured IOP using the Ocular Response Analyzer. Three readings were taken per eye and the best signal value of the Goldmann-correlated IOP value considered. Participants were asked to bring all their medications and related documentation to the health examination, and these were recorded by the research nurse using an electronic case record form. The medication classes examined were angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, α-blockers, β-blockers, calcium channel blockers, diuretics, nitrates, statins, insulin, biguanides, sulfonylureas, aspirin, and other nonsteroidal anti-inflammatory drugs. We examined associations between medication use and IOP using multivariable linear regression models adjusted for age, sex, and body mass index. Models containing diabetic medication were further adjusted for glycosylated hemoglobin levels. Main Outcome Measures Mean IOP of the right and left eyes. Results Use of systemic β-blockers (-0.92 mmHg; 95% CI, -1.19, -0.65; P<0.001) and nitrates (-0.63 mmHg; 95% CI, -1.12, -0.14; P = 0.011) were independently associated with lower IOP. The observed associations between statin or aspirin use with IOP were no longer significant after adjustment for β-blocker use. Conclusions This is the first population-based study to demonstrate and quantify clinically significant differences in IOP among participants using systemic β-blockers or nitrates. Lower IOP observed in participants using statins or aspirin was explained by concurrent systemic β-blocker use. The study findings may have implications for the management of glaucoma patients with comorbidity, and may provide insight into the pathophysiologic processes underlying IOP.

Original languageEnglish
Pages (from-to)1501-1507
Number of pages7
Issue number8
Publication statusPublished - Aug 2014
Externally publishedYes

Bibliographical note

Funding Information:
Financial Support: EPIC-Norfolk infrastructure and core functions are supported by grants from the Medical Research Council ( G1000143 ) and Cancer Research UK ( C864/A14136 ). The clinic for the third health examination was funded by Research into Ageing (262). A.P.K. is a Wellcome Trust funded Clinical Research Fellow . P.J.F. has received additional support from the Richard Desmond Charitable Trust (via Fight for Sight) and the Department for Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital and the UCL Institute of Ophthalmology for a specialist Biomedical Research Centre for Ophthalmology . None of the funding organizations had a role in the design or conduct of the research.


  • Abbreviations and Acronyms
  • blood pressure
  • BMI
  • body mass index
  • BP
  • EPIC
  • European Prospective Investigation into Cancer
  • intraocular pressure
  • IOP
  • Ocular Response Analyzer
  • ORA
  • SPB
  • systolic BP


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