Effects of calcium channel blockers on visual field progression in glaucoma patients

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Researchers from UK and Italian institutions investigated the association between the effects of calcium channel blockers and the rate of visual field (VF) progression in patients with glaucoma. First author Giovanni Montesano, MD, PhD, and colleagues reported that the drugs were significantly associated with a slower rate of VF deterioration. Montesano is from the NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology and the Department of Optometry and Visual Sciences, City St. George’s, University of London, all in London.

Researchers from Ophthalmology Unit, University Hospital Maggiore della Carità, and the Department of Health Sciences, Università del Piemonte Orientale “A. Avogadro,” both from Novara, Italy, also participated in this study.

Calcium channel blockers are among the most commonly prescribed medications to treat cardiovascular conditions, with up to 40% of patients with systemic hypertension using them to control blood pressure2; in addition, this drug class represents about 4% of all primary care prescriptions,3 according to the investigators.

Up to now, controversy has existed around the effect of system calcium channel blocks on the visual fields, ranging from studies that found a consistent association between the drugs and diagnosis of glaucoma,4-8 and between the drugs and glaucoma-related traits.7,9 In contrast, others have either shown no association13 or a protective association,10-13 the authors explained.

To more definitively clarify the effects of calcium channel blockers, the researchers undertook a retrospective longitudinal case-control study that included patients from five glaucoma clinics in the UK using the same electronic medical record (EMR) system.

One eye of each patient was included that had a minimum of five reliable VFs over a period of at least 4 years. The EMR system provided information about the use of calcium channel blockers. Linear mixed-effect models were used to test the effect on the rate of VF mean deviation (MD) associated with use of calcium channel blockers and other covariates.

The main outcome was the mean difference in the rate of VF MD progression between patients who used calcium channel blockers and the controls.

The study included 14,475 eyes, of which 1,942 were from patients taking calcium channel blockers.

The analysis showed that the median (interquartile range) VF series length was eight (6, 11) tests, with a follow-up of 8.6 (6, 11.5) and 8.2 (5.9, 11.2) years in patients who used calcium channel blocks and controls, respectively.

“The estimated rate of MD progression was −0.31 (−0.33 to −0.28) decibels (dB)/year (mean and 95% confidence intervals in the patients who used calcium channel blocks and −0.35 (−0.37 to −0.33) dB/year in the matched controls (P = 0.016). This significant difference was confirmed with the multivariate analysis including all controls (P = 0.020). All sensitivity analyses confirmed the main results,” Montesano and colleagues reported.

“We found a significant association between calcium channel blocker use and a marginally slower rate of progression, after adjusting for multiple confounders. We confirmed this finding with additional sensitivity analyses, using either a less stringent criteria for the inclusion of patients in the analyzed cohort or a more stringent criteria for the definition of calcium channel blocker exposure. All analyses, however, confirmed an estimated small average difference in the rate of VF deterioration between patients who used calcium channel blockers and controls, which is likely not clinically significant,” they said.

They advised interpretation of the results in the context of the limited information regarding calcium channel blocker exposure in this cohort, which did not include precise data on patients’ general health and the duration and dose of calcium channel blocker exposure, which might dilute the magnitude of the true association.

“Further analyses with better characterized cohorts might show different results in specific subgroups. Ultimately, the magnitude of any potential effect, whether detrimental or protective, could only be estimated with carefully designed RCTs,” they concluded.

References
  1. Montesano G, Rabiolo A, Garway-Heath DF, et al. Association of systemic calcium channel blocker use with visual field progression in a large real-world cohort from glaucoma clinics. Ophthalmol Glaucoma. 2025;8:333-42. https://www.ophthalmologyglaucoma.org/article/S2589-4196(25)00043-2/fulltext
  2. Lloyd-Jones, DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA. 2005;294:466-472.
  3. Audi S, Burrage DR, Lonsdale DO. The ‘top 100’ drugs and classes in England: an updated ‘starter formulary’ for trainee prescribers. Br J Clin Pharmacol. 2018;84:2562-2571
  4. Muskens RP, de Voogd S, Wolfs RC. Systemic antihypertensive medication and incident open-angle glaucoma. Ophthalmology. 2007; 114:2221-2226.
  5. Zheng W, Dryja TP, Wei Z. Systemic medication associations with presumed advanced or uncontrolled primary open-angle glaucoma. Ophthalmology. 2018;125:984-993.
  6. Vergroesen, JE, Schuster AK, Stuart KV. Association of systemic medication use with glaucoma and intraocular pressure: the European eye epidemiology consortium. Ophthalmology. 2023;130:893-906.
  7. Kastner A, Stuart KV, Montesano G. Calcium channel blocker use and associated glaucoma and related traits among UK biobank participants. JAMA Ophthalmol. 2023;141:956-964.
  8. Tavakoli K, Sidhu S, Saseendrakumar BR. Long term systemic use of calcium channel blockers and incidence of primary open angle glaucoma. Ophthalmol Glaucoma. 2024;7:491-498.
  9. Chong RS, Chee ML, Tham YC. Association of antihypertensive medication with retinal nerve fiber layer and ganglion cell-inner plexiform layer thickness. Ophthalmology. 2021;128:393-400.
  10. Koseki N, Araie M, Yamagami J. Effects of oral brovincamine on visual field damage in patients with normal-tension glaucoma with low-normal intraocular pressure. J Glaucoma. 1999;8:117-123.
  11. Koseki N, Araie M, Tomidokoro A. A placebo-controlled 3-year study of a calcium blocker on visual field and ocular circulation in glaucoma with low-normal pressure. Ophthalmology. 2008;115:2049-2057.
  12. Daugeliene L, Yamamoto T, Kitazawa Y. Risk factors for visual field damage progression in normal-tension glaucoma eyes. Graefes Arch Clin Exp Ophthalmol. 1999;237:105-108.
  13. Ishida K, Yamamoto T, Kitazawa Y. Clinical factors associated with progression of normal-tension glaucoma. J Glaucoma. 1998;7:372-377.

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