{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:49:30Z","timestamp":1785890970538,"version":"3.56.0"},"reference-count":30,"publisher":"BMJ","funder":[{"name":"Taichung Veterans General Hospital, Taiwan","award":["TCVGH-1152201B"],"award-info":[{"award-number":["TCVGH-1152201B"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,6,30]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the association between tadalafil use for lower urinary tract symptoms (LUTS) and the risk of developing glaucoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multinational, retrospective cohort study was conducted using the TriNetX database. Men aged \u226540 years with a history of LUTS were enrolled between 2012 and 2022. Individuals with a history of glaucoma prior to cohort entry were excluded. Participants were categorised into the tadalafil group and the non-phosphodiesterase type 5 inhibitor (non-PDE5i) group. Propensity score matching (1:1) was conducted to balance age, race, comorbidities, renal function and concomitant medications. Hazard ratios (HRs) were estimated for incident glaucoma of different subtypes and initiation of glaucoma treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 36\u2009927 tadalafil users and 36\u2009927 matched non-PDE5i users. Up to 5 years, tadalafil use was associated with an increased risk of glaucoma compared with non-PDE5i use (HR 1.22; 95%\u2009CI 1.12 to 1.33). Elevated risks were observed for ocular hypertension (HR 1.32; 95% CI 1.06 to 1.65), primary open-angle glaucoma (HR 1.33; 95% CI 1.05 to 1.67) and initiation of glaucoma treatment (HR 1.33; 95% CI 1.20 to 1.47). No significant associations were found for low-tension or primary angle-closure glaucoma. Tadalafil users had a higher 5-year cumulative incidence than non-users (3.93% vs 3.16%; p&lt;0.001), with consistent risk in men &gt;50 years, white population and across comorbidities, remaining robust to 1-, 3- and 6-month lag times.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Tadalafil was associated with increased risk of glaucoma compared with non-PDE5i in males with LUTS. Ophthalmic evaluation and follow-up may be considered, particularly in patients with risk factors for glaucoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2026-329957","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:14Z","timestamp":1785888014000},"page":"bjo-2026-329957","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of glaucoma among patients using tadalafil for lower urinary tract symptoms: a multinational cohort study"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6972-7732","authenticated-orcid":false,"given":"Yun","family":"Hsia","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"Department of Ophthalmology, National Taiwan University Hospital Hsin-chu Branch, Hsinchu, Taiwan"},{"name":"College of Medicine, National Taiwan University, Taipei, Taiwan"},{"name":"Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Yun","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Chun","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, National Chung Hsing University, Taichung, Taiwan"},{"name":"Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Peng","family":"Chen","sequence":"additional","affiliation":[{"name":"Biostatistics Group, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4620-1755","authenticated-orcid":false,"given":"Ssu-Yu","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2606-8540","authenticated-orcid":false,"given":"Hui-Ju","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan"},{"name":"Eye Centre, China Medical University Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3045-0614","authenticated-orcid":false,"given":"I-Jong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0794-1263","authenticated-orcid":false,"given":"Chien-Hsiang","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA"},{"name":"Brown University Health, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi-Hyun","family":"Nam","sequence":"additional","affiliation":[{"name":"Sue Anschutz-Rodgers Eye Centre, University of Colorado System, Denver, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3332-0900","authenticated-orcid":false,"given":"Chien-Chih","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, National Chung Hsing University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"2026080417000733000_bjo-2026-329957v1.1","doi-asserted-by":"crossref","first-page":"248","DOI":"10.18502\/jovr.v16i2.9088","article-title":"Phosphodiesterase Type 5 Inhibitors and Visual Side Effects: A Narrative Review","volume":"16","author":"Barroso","year":"2021","journal-title":"J Ophthalmic Vis Res"},{"key":"2026080417000733000_bjo-2026-329957v1.2","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.ucl.2025.08.001","article-title":"Medical Therapy for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms","volume":"52","author":"Te","year":"2025","journal-title":"Urol Clin North Am"},{"key":"2026080417000733000_bjo-2026-329957v1.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000146906.42375.D3"},{"key":"2026080417000733000_bjo-2026-329957v1.4","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1002\/pds.4405","article-title":"Risk of sudden sensorineural hearing loss in adults using phosphodiesterase type 5 inhibitors: Population-based cohort study","volume":"27","author":"Liu","year":"2018","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2026080417000733000_bjo-2026-329957v1.5","doi-asserted-by":"publisher","DOI":"10.1007\/s40266-020-00796-5"},{"key":"2026080417000733000_bjo-2026-329957v1.6","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1001\/jamaophthalmol.2022.0663","article-title":"Risk of Ocular Adverse Events Associated With Use of Phosphodiesterase 5 Inhibitors in Men in the US","volume":"140","author":"Etminan","year":"2022","journal-title":"JAMA Ophthalmol"},{"key":"2026080417000733000_bjo-2026-329957v1.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(01)00976-9"},{"key":"2026080417000733000_bjo-2026-329957v1.8","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1093\/jsxmed\/qdad137","article-title":"Use of phosphodiesterase 5 inhibitors is not associated with ocular adverse events","volume":"20","author":"Belladelli","year":"2023","journal-title":"J Sex Med"},{"key":"2026080417000733000_bjo-2026-329957v1.9","doi-asserted-by":"crossref","first-page":"172","DOI":"10.4103\/tjosr.tjosr_56_25","article-title":"Risk of Glaucoma in Men Taking Sildenafil: A Propensity-Score-Matched Study","volume":"63","author":"Freyaldenhoven","year":"2025","journal-title":"TNOA J Ophthalmic Sci Res"},{"key":"2026080417000733000_bjo-2026-329957v1.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0183388","article-title":"Use of phosphodiesterase inhibitors and prevalence of self-reported glaucoma in the United States","volume":"12","author":"Chen","year":"2017","journal-title":"PLoS One"},{"key":"2026080417000733000_bjo-2026-329957v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.exer.2011.05.010"},{"key":"2026080417000733000_bjo-2026-329957v1.12","doi-asserted-by":"publisher","DOI":"10.1001\/archophthalmol.2009.36"},{"key":"2026080417000733000_bjo-2026-329957v1.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-3768.2011.02305.x"},{"key":"2026080417000733000_bjo-2026-329957v1.14","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2007.131789"},{"key":"2026080417000733000_bjo-2026-329957v1.15","first-page":"630","article-title":"Phosphodiesterase inhibitors in glaucoma (PhIGS): a prospective OCTA study","volume":"61","author":"Yap","year":"2020","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026080417000733000_bjo-2026-329957v1.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.11.022"},{"key":"2026080417000733000_bjo-2026-329957v1.17","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s10792-021-02137-w","article-title":"Systemic diseases and their association with open-angle glaucoma in the population of Stockholm","volume":"42","author":"W\u00e4ndell","year":"2022","journal-title":"Int Ophthalmol"},{"key":"2026080417000733000_bjo-2026-329957v1.18","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.ophtha.2024.08.023","article-title":"Comparative Effects of Glucagon-like Peptide 1 Receptor Agonists and Metformin on Glaucoma Risk in Patients with Type 2 Diabetes","volume":"132","author":"Muayad","year":"2025","journal-title":"Ophthalmology"},{"key":"2026080417000733000_bjo-2026-329957v1.19","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1007\/s40266-019-00699-0","article-title":"Precautions and Monitoring of Patients Taking Phosphodiesterase Type 5 Inhibitors Who are at Risk of Increased Intraocular Pressure","volume":"36","author":"Baker","year":"2019","journal-title":"Drugs Aging"},{"key":"2026080417000733000_bjo-2026-329957v1.20","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1038\/sj.eye.6702908","article-title":"Expression of the PDE5 enzyme on human retinal tissue: new aspects of PDE5 inhibitors ocular side effects","volume":"22","author":"Foresta","year":"2008","journal-title":"Eye (Lond)"},{"key":"2026080417000733000_bjo-2026-329957v1.21","doi-asserted-by":"crossref","first-page":"3407","DOI":"10.2147\/DDDT.S118015","article-title":"Pathophysiology of visual disorders induced by phosphodiesterase inhibitors in the treatment of erectile dysfunction","volume":"8","author":"Moschos","year":"2016","journal-title":"Drug Des Devel Ther"},{"key":"2026080417000733000_bjo-2026-329957v1.22","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.14-14515"},{"key":"2026080417000733000_bjo-2026-329957v1.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(01)01268-5"},{"key":"2026080417000733000_bjo-2026-329957v1.24","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5489\/cuaj.371","article-title":"Urologic medications and ophthalmologic side effects: a review","volume":"6","author":"Gani","year":"2012","journal-title":"Can Urol Assoc J"},{"key":"2026080417000733000_bjo-2026-329957v1.25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0420.2006.00803.x"},{"key":"2026080417000733000_bjo-2026-329957v1.26","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12726"},{"key":"2026080417000733000_bjo-2026-329957v1.27","first-page":"849","article-title":"Dysfunctional regulation of ocular blood flow: A risk factor for glaucoma?","volume":"2","author":"Moore","year":"2008","journal-title":"Clin Ophthalmol"},{"key":"2026080417000733000_bjo-2026-329957v1.28","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/IJG.0000000000002152","article-title":"Validity of Algorithms to Identify Patients With Glaucoma Using the Japanese Claims Data","volume":"32","author":"Fujita","year":"2023","journal-title":"J Glaucoma"},{"key":"2026080417000733000_bjo-2026-329957v1.29","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.survophthal.2025.07.001","article-title":"Trabecular meshwork: A pivotal target for evolving glaucoma treatments","volume":"70","author":"Wan","year":"2025","journal-title":"Surv Ophthalmol"},{"key":"2026080417000733000_bjo-2026-329957v1.30","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.niox.2018.04.010","article-title":"The nitric oxide-guanylate cyclase pathway and glaucoma","volume":"77","author":"Wareham","year":"2018","journal-title":"Nitric Oxide"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2026-329957","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:17Z","timestamp":1785888017000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2026-329957"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":30,"alternative-id":["10.1136\/bjo-2026-329957"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2026-329957","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}