Montesano Giovanni, Rabiolo Alessandro, Garway-Heath David F, Fu Dun Jack, Gazzard Gus, Ometto Giovanni, Crabb David P, Khawaja Anthony P
NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Department of Optometry and Visual Sciences, City St. George's, University of London, London, United Kingdom.
Ophthalmology Unit, University Hospital Maggiore della Carità, Novara, Italy; Department of Health Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy.
Ophthalmol Glaucoma. 2025 Jul-Aug;8(4):333-342. doi: 10.1016/j.ogla.2025.03.002. Epub 2025 Mar 13.
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.
Retrospective longitudinal case-control study.
Patients attending 5 glaucoma clinics in the United Kingdom using the same electronic medical record (EMR) system.
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.
The mean difference in the rate of VF MD progression between CCB users and controls.
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.
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.
在来自5家青光眼诊所的一大群患者中，测试钙通道阻滞剂（CCB）药物的使用与视野（VF）进展速率之间的关联。
回顾性纵向病例对照研究。
在英国使用同一电子病历（EMR）系统的5家青光眼诊所的患者。
在主要分析中，我们从在至少4年期间有至少5次可靠（假阳性误差<15%）视野检查的患者中选择1只眼睛。全身用药情况来自EMR系统。使用钙通道阻滞剂的患者被确定为病例组。倾向评分匹配（PSM）和多变量分析（MVA）用于调整混杂因素。相关变量的有向无环图指导协变量的选择。线性混合效应模型（LMMs）用于测试CCB使用及其他协变量对视野平均偏差（MD）进展速率的影响（用于多变量分析）。采用不同的纳入标准和CCB使用估计持续时间的截断值进行敏感性分析。
CCB使用者与对照组之间视野MD进展速率的平均差异。
主要分析纳入了14475只眼睛（1942只来自CCB使用者），这些眼睛符合选择标准（每位患者1只眼睛）。视野系列长度的中位数（四分位间距）为8（6，11）次检查，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使用者均与对照组实现了一对一的PSM配对。CCB使用者的MD进展估计速率为-0.31（-0.33至-0.28）dB/年（均值[95%置信区间]），匹配对照组为-0.35（-0.37至-0.33）dB/年（P = 0.016）。包括所有对照组的多变量分析证实了这一显著差异（P = 0.020）。所有敏感性分析均证实了主要结果。
多变量调整后，使用钙通道阻滞剂与视野恶化速率较慢在统计学上显著相关。估计差异较小，可能无临床意义，但可能受该队列中CCB暴露持续时间信息有限的影响。
本文末尾的脚注和披露中可能会有专有或商业披露信息。
