title: Effects of selective serotonin reuptake inhibitors on glaucoma: A nationwide population-based study.
abstract: BACKGROUND
  Selective serotonin reuptake inhibitors (SSRIs) are one of the most commonly prescribed classes of antidepressants. Glaucoma is the second leading cause of blindness globally and iatrogenic glaucoma has been implicated across disparate medication classes. Available studies that have sought to determine the association between SSRI exposure and glaucoma have provided mixed results. The aim of the study herein was to investigate whether an association exists between SSRI exposure and glaucoma incidence.
  
  
  METHODS
  Glaucoma cases were identified from Taiwan's National Health Insurance Research Database with a new primary diagnosis of glaucoma between 1997 and 2009. The date wherein the cases were diagnosed with glaucoma was operationalized as the index date. The control group was comprised of individuals within the database who were not diagnosed with glaucoma. 15,865 glaucoma cases were compared to 77,014 sex-, age-, residence- and insurance premium-matched controls on measures of prescribed duration and dosage of SSRIs up to 365 days before index date to proxy SSRIs exposure.
  
  
  RESULTS
  Individuals receiving SSRIs were at greater risk of glaucoma incidence (OR = 1.39; 95% CI = 1.29-1.50); the foregoing increased likelihood was reduced after adjusting for confounding variables (aOR = 1.09; 95% CI = 1.00,1.18). SSRI treatment of longer duration (i.e. >365 days) and higher doses (≥1 defined daily dose) were associated with greater risk of glaucoma incidence (aOR = 1.36; 95% CI = 1.08-1.71). Subgroup analysis showed that the effect of SSRIs on glaucoma was limited to individuals younger than 65 years of age (aOR = 1.37; 95% CI = 1.25-1.50), without diabetes (aOR = 1.39; 95% CI = 1.27-1.52), without hypertension (aOR = 1.46; 95% CI = 1.31-1.63) or hypercholesterolemia (aOR = 1.35; 95% CI = 1.23-1.48).
  
  
  CONCLUSIONS
  Treatment with SSRIs was associated with greater risk of having a diagnosis of glaucoma, particularly in individuals with longer duration and/or higher average dose of SSRI. Our findings suggest that individuals receiving SSRIs treatment for extended periods of time and/or at relatively higher therapeutic doses should be monitored for symptoms associated with glaucoma.
authors.affiliation: Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.|Department of Psychiatry, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Vincent Chin-Hung
authors.initials: VC
authors.lastname: Chen
authors.affiliation: Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan.|PhD Student of Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Mei-Hing
authors.initials: MH
authors.lastname: Ng
authors.affiliation: Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan.|College of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Chiu
authors.affiliation: Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada.|Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada.
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.affiliation: Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Yena
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan.
authors.forename: Tsang-Yaw
authors.initials: TY
authors.lastname: Lin
authors.affiliation: Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Jun-Cheng
authors.initials: JC
authors.lastname: Weng
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
authors.forename: Pau-Chung
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Neurology, Kaoshiung Medical University Hospital, Kaoshiung, Taiwan.|Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chung-Yao
authors.initials: CY
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D016208:Databases, Factual; D003863:Depression / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005901:Glaucoma / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors