Blind Spots in Therapy: Unveiling Drug-Induced Angle-Closure Glaucoma Through a National Analysis

To identify and quantify medications causing angle-closure glaucoma through the FDA Federal Adverse Event Reporting System (FAERS). National, retrospective database analysis. 11,737,133 total adverse event reports from the FDA Federal Adverse Event Reporting System (FAERS) database 2004-2022Q3, which included 1,629 reports of angle-closure glaucoma. Drugs associated with reports of angle-closure glaucoma were identified in FAERS. To ascertain if these reports yielded statistically significant signals, we used the proportional reporting ratio (PRR), reporting odds ratio (ROR), empirical Bayes geometric mean (EBGM), and information component (IC) as a part of a disproportionality analysis. We considered a signal to be detected when all four disproportionality analysis metrics were positive. We identified a total of 1,629 adverse event reports linked to 611 suspected drugs over the course of 20 years (2004-2023Q3). Frequently reported drugs included topiramate (520 reports) and citalopram (69 reports), amongst many others. 18 medications yielded a positive signal, including lesser-known medications like olanzapine, phentermine, and ranibizumab. Tropicamide exhibited the most robust statistical significance (n=18; PRR: 164.263; ROR (95% CI): 167.95 (104.994-268.655); EBGM (EBGM05): 162.421 (109.5); IC (IC05): 7.344 (4.591)), while acetazolamide was the second strongest (n=51; PRR: 113.088; ROR 95% CI: 114.782 (86.665-152.021); EBGM (EBGM05): 109.506 (86.501); IC (IC05): 6.775 (5.115)). Drug-induced glaucoma included both well-known medications such as topiramate as well as lesser-known medications such as olanzapine, phentermine, and ranibizumab. Clinician awareness of these findings is important.