Association of Systemic Calcium Channel Blocker Use with Visual Field Progression in a Large Real-World Cohort from Glaucoma Clinics

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma Pub Date : 2025-07-01 DOI:10.1016/j.ogla.2025.03.002

Giovanni Montesano MD, PhD , Alessandro Rabiolo MD , David F. Garway-Heath MD , Dun Jack Fu MD, PhD , Gus Gazzard MD , Giovanni Ometto PhD , David P. Crabb PhD , Anthony P. Khawaja PhD, FRCOphth

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Abstract

Purpose

To test the association between use of calcium channel blocker (CCB) medications and the rate of visual field (VF) progression in a large cohort of patients from 5 glaucoma clinics.

Design

Retrospective longitudinal case-control study.

Subjects

Patients attending 5 glaucoma clinics in the United Kingdom using the same electronic medical record (EMR) system.

Methods

For the main analysis, we selected 1 eye from patients with at least 5 reliable (false positive errors < 15%) VFs over a period of at least 4 years. The use of systemic medications was derived from the EMR system. Calcium channel blocker users were identified as cases. Propensity score matching (PSM) and multivariable analyses (MVAs) were used to adjust for confounders. A directed acyclic graph of the relevant variables guided the selection of covariates. Linear mixed-effect models (LMMs) were used to test the effect on the rate of VF mean deviation (MD) associated with CCB use and other covariates (for the MV analysis). Sensitivity analyses were conducted with different inclusion criteria and cutoffs on the estimated duration of CCB use.

Main Outcome Measures

The mean difference in the rate of VF MD progression between CCB users and controls.

Results

The main analysis included 14 475 eyes (1942 from CCB users) that met the selection criteria (1 eye per patient). The median (interquartile range) VF series length was 8 (6, 11) tests, with a follow-up of 8.6 (6, 11.5) and 8.2 (5.9, 11.2) years in CCB users and controls, respectively. One-to-one PSM pairing with controls was achieved for all CCB users. The estimated rate of MD progression was −0.31 (−0.33 to −0.28) dB/year (mean [95% confidence intervals]) in the CCB users and −0.35 (−0.37 to −0.33) dB/year in the matched controls (P = 0.016). This significant difference was confirmed with the MV analysis including all controls (P = 0.020). All sensitivity analyses confirmed the main results.

Conclusions

Calcium channel blocker use was statistically significantly associated with a slower rate of VF deterioration after multivariable adjustment. The estimated difference was small and likely not clinically significant but may be influenced by the limited information on the duration of CCB exposure in this cohort.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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来自青光眼诊所的大型真实世界队列中，全身使用钙通道阻滞剂与视野恶化之间的关系。

目的：在来自5个青光眼诊所的大队列患者中，测试钙通道阻滞剂（CCB）药物的使用与视野（VF）进展率之间的关系。设计：回顾性、纵向病例对照研究。研究对象：英国5家青光眼诊所的患者使用相同的电子医疗记录（EMR）系统。方法：作为主要分析，我们选择了至少4年内至少有5个可靠（假阳性误差< 15%）VFs的患者的一只眼睛。全身性药物的使用源自电子病历系统。CCB用户被确定为病例。使用倾向得分匹配（PMS）和多变量分析（MV）来调整混杂因素。相关变量的有向无环图（DAG）指导协变量的选择。使用线性混合效应模型（lmm）检验CCB使用和其他协变量（用于MV分析）对VF平均偏差（MD）率的影响。采用不同的纳入标准和截止值对CCB的估计使用时间进行敏感性分析。主要结果测量：CCB使用者和对照组之间VF MD进展率的平均差异。结果：主分析纳入符合入选标准（每例1眼）的14475只眼（其中1942只来自CCB使用者）。VF序列长度的中位数[四分位间距]为8[6,11]次，CCB使用者和对照组的随访时间分别为8.6[6,11.5]年和8.2[5.9,11.2]年。所有CCB用户都实现了与控件的一对一PSM配对。CCB患者的MD进展率估计为-0.31 [-0.33,-0.28]dB/年（平均[95%可信区间]），匹配对照组为-0.35 [-0.37,-0.33]dB/年（p = 0.016）。MV分析证实了这一显著差异，包括所有对照组（p = 0.020）。所有敏感性分析均证实了主要结果。结论：经多变量调整后，CCB的使用与VF恶化速度较慢有统计学意义。估计的差异很小，可能没有临床意义，但可能受到该队列中CCB暴露时间信息有限的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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