Study design, materials and methods
Retrospective multicenter observational study of 1203 women treated for overactive bladder (OAB) before January 1st, 2019. Patients should have undergone at least an ophthalmologic review in the last year. Patients with amaurosis, amblyopia and retinal pathology were excluded.
The patients were divided into three groups according to their ophtalmological background:
GA (n = 255): patients with OAB and non-glaucoma eye disease;
GB (n = 681): patients with OAB without ocular pathology;
GC (n = 267): patients with OAB and glaucoma.
Different OAB treatments were analysed (subgroups):
1: Onabotulinum toxinA,
5: Pelvic floor muscle training (PFMT),
Variables: age, BMI, evolution time, ASA, secondary diagnoses, eye health evolution.
Descriptive statistics, Student's t, Chi2, Fisher, ANOVA, multivariate analysis, risk analysis; p <0.05 was considered significant.
Mean age 64.48 years (range 19-85), lower in GB. Lower in GB; GA: average 70 years (41-82), lower in GA2: average GB 61.78 years (19-85), there were no differences in the subgroups; GC: average 66.02 years (49-78), was lower in GC1 and GC5.
In the general sample, OAB treatment does influence the appearance of de novo eye disease.
The risk of dry eye or conjunctivitis for each treatment in the general sample are:
- Fesoterodine: the risk is 0,12 less;
- Mirabregon: not significant;
- Oxybutynin: ethe risk is 0,53 less;
- PFMT: not significant;
- Solifenacine: the risk is 2,10 higher;
- Tolterodine: not significant.
* Group A: higher risk with solifenacin (7.32), fesoterodine (4.80), oxybutynin (4.26), mirabregon (2,75) and less with tolterodine (1,86).
* Group B: lower risk with oxybutynin (0,505), PFMT (0,279) and solifenacine (0,059).
* Group C: no treatment showed a statistical significant influence on the appearance of de novo ocular pathology.
Psychiatric pathology: depression (%): GA-48.78, GB-21.95, GC-29.27;
Anxiety (%): GA-71.43, GB-21.43, GC-7.14%.
Fibromyalgia (%): GA-19.23, GB-30.77, GC-50.00.
Prolapse (%): GA-5.88, GB-35.29, GC-58.82%.
Interpretation of results
It is well described that anticholinergics should be avoided in patients with high intraocular pressure, and that dry mouth and blurred vision may be disturbing side effects leading to treatment withdrawal. However, other ophthalmological disorders may also appear, like dry eye and recurrent conjunctivitis. Patients with glaucoma received more often PFMT for this reason, and patients with other ophtalmological disorders were more frequenlty treated with anticholinergics (Solifenacine, Oxybutynin, Tolterodine and Fesoterodine). On the other side, botulinum toxin and mirabegron were more often indicated in the group of patients with no ophtalmological background, but a higher incidence of diabetes mellitus was found in this group that could influence the treatment choice.