Increased near add power in pre-presbyopic glaucoma patients treated with medication.

Clinical relevance: Near add power increases earlier in glaucoma patients than non-glaucoma subjects. Although many factors have been proposed to be implicated in this, the role of glaucoma medication in the progression of presbyopia remains unclear.

Background: The aim of this work is to investigate whether glaucoma medication accelerates the progression of presbyopia in glaucoma patients by comparing with near add power in control subjects at pre-presbyopia ages.

Methods: A retrospective cross-sectional study was performed on consecutive subjects attending the Otake Eye Clinic, Kanagawa, Japan, and included bilateral phakic participants aged 30-39 years. The cohort comprised 187 controls (mean age 36.0 ± 2.7 years) and 106 patients with primary open-angle glaucoma (mean age 35.8 ± 2.7 years) who had been using topical glaucoma medication for over six months. The near add power and other ocular parameters were then compared between the two groups.

Results: The mean near add power and the prevalence of near add power ≥ 1.50 D were 0.91 ± 0.74 D and 20.9% for controls, and 1.61 ± 0.71 D (p < 0.01) and 51.9% (p < 0.01) for glaucoma group, respectively. Univariable regression analysis of near add power and ocular parameters in the control group indicated that age, myopic errors, astigmatism, anisometropia, full macular thickness, ganglion cell complex thickness, and retinal nerve fibre layer thickness were significantly associated with near add power. Kaplan-Meier survival analysis showed that the glaucoma group reached the endpoint of near add power of + 1.50 D significantly earlier than controls (p < 0.01, log-rank test).

Conclusion: Glaucoma patients aged 30-39 years exhibited higher near add power compared to controls. These findings could help improve the management of glaucoma patients with early presbyopia.