Erectile dysfunction treatment was linked to slightly higher glaucoma risk

Design

Nested case-control study, UK primary care (CPRD Gold and Aurum)

Population

218,056 men with POAG and 876,872 matched controls

Primary outcome

Association of erectile dysfunction medication with POAG

Effect

OR 1.29 (1.25–1.32) Gold; OR 1.17 (1.15–1.18) Aurum

This nested case-control study, published in the British Journal of Ophthalmology on 11 September, used two UK primary care databases. It compared 218,056 men with primary open-angle glaucoma with 876,872 matched controls.

Erectile dysfunction medication had been prescribed to 20% of cases and 17% of controls. After adjustment for age, ethnicity and deprivation, use was associated with higher glaucoma risk (OR 1.29 in one database, 1.17 in the other). Older age, Black or Asian ethnicity, hypertension, diabetes, asthma, migraine and sickle cell disease were also associated with glaucoma.

The authors read this as a marker of vascular disease rather than a drug effect, since these medicines are taken on demand. It is an association adjusted for few confounders, and it gives no reason to withhold treatment for erectile dysfunction.

• Do not stop erectile dysfunction treatment because of this finding.
• Consider erectile dysfunction a possible marker of vascular risk relevant to glaucoma.
• Keep glaucoma screening focused on age, ethnicity and family history.
• Ask men with vascular risk factors when their eyes were last checked.

Why it matters

It adds indirect support to a vascular contribution to open-angle glaucoma.

Don't overread it

This was observational with limited adjustment; it does not show that the drugs cause glaucoma.

The statistics, in plain English

Odds ratios of 1.17 to 1.29 mean modestly higher odds, about a fifth. With nearly a million men, the intervals are narrow, but narrow intervals do not remove confounding by vascular disease.

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