Author’s Disclosure Block: Kate Lim, none; Hoyoung Jung, none; Korolos Sawires, none; Bonnie He, none; Brennan Eadie, none; Edsel Ing, none

Abstract Body
Purpose:Various case reports and studies based on adverse drug event reporting systems have explored a potential association between topiramate therapy and the onset of glaucoma. However, there is no definitive consensus within the literature that substantiates this connection. This study aims to investigate the potential link between topiramate use and the development of glaucoma. Additionally, it seeks to identify patterns related to glaucoma onset, such as the duration of topiramate therapy preceding the condition’s development. Study Design: A systematic review and meta-analysis
Methods: MEDLINE and EMBASE were searched from inception to June 2024 for original studies reporting the incidence of glaucoma following the initiation of topiramate. A total of 4,398 studies were screened by two independent reviewers, with conflicts resolved by a third reviewer. Ultimately, three studies were selected for data extraction by two independent reviewers. The studies included in this systematic review encompassed over 181,000 individuals diagnosed with glaucoma. Results: Three case-control studies based in the United States were included in this systematic review. These studies utilized a large health claims database in the United States. The mean age of participants across the studies was 59.8 years (54.6 - 65), with 37.2% male and 62.8% female. All studies reported the incidence of acute angle-closure glaucoma using unadjusted relative risk. Of the 181,125 individuals diagnosed with glaucoma, 0.2% had been prescribed topiramate.The average unadjusted relative risk of developing glaucoma after initiating topiramate was 2.57. The meta-analysis yielded an effect size of 0.0106 (p = 0.0555, 95% CI: -0.0002 to 0.0214), with a lower confidence interval bound of -0.0002. The I² statistic, measuring heterogeneity, was 94.34%, indicating considerable heterogeneity across the studies. Conclusion: This study is the first to assess the association between topiramate use and the onset of glaucoma based on present studies in the literature. While numerous case reports and data from adverse drug reporting systems have highlighted concerns about the potential risk of glaucoma following topiramate use, this study did not find a statistically significant association between the two. Also, the significant heterogeneity in studies was one of the critical limitations of this study. Further research with larger sample sizes is needed to strengthen the certainty of these findings. Given the broad medical indications and widespread use of topiramate for conditions such as epilepsy, migraine management, and weight control, it is crucial for clinicians to remain vigilant about the potential ocular risks associated with its use.