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The eye check men taking Cialis shouldn’t skip
Men don’t always love talking about urinary symptoms.
But when an enlarged prostate starts sending you to the bathroom again and again — especially at night — it can affect everything from sleep to confidence to daily comfort.
That’s why a medication like tadalafil can feel like a welcome answer.
Most people know tadalafil by the brand name Cialis and associate it with erectile dysfunction. But it’s also prescribed for lower urinary tract symptoms caused by an enlarged prostate, also called benign prostatic hyperplasia or BPH.
And unlike occasional use for sexual function, tadalafil for urinary symptoms may be taken daily over a long period.
That’s where new research raises an important question…
Could a drug that helps one part of the body create trouble for another — especially the eyes?
A large new study suggests there may be reason to pay closer attention to eye health in men who take tadalafil long term.
Quick Answer: Can long-term Cialis use affect glaucoma risk?
A large observational study of nearly 74,000 men found that tadalafil use for urinary symptoms was associated with a 22% higher risk of glaucoma and a 32% higher risk of elevated eye pressure.
The study does not prove tadalafil causes glaucoma.
But the researchers say baseline eye assessment and regular follow-up may be worth considering, particularly for men with existing glaucoma risk factors or those who require long-term therapy.
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Why glaucoma can develop without obvious symptoms
Glaucoma can quietly damage vision before a person realizes anything is wrong.
It damages the optic nerve — the cable that carries visual information from the eye to the brain. High pressure inside the eye is a major risk factor, although glaucoma can also occur when eye pressure is not dramatically elevated.
The most common form, primary open-angle glaucoma, often has no early symptoms.
No pain.
No obvious warning.
No dramatic change in vision at first.
That’s why eye exams can be so easy to postpone — until you realize what’s at stake.
We’ve written before about why regular eye exams can catch glaucoma before vision loss or blindness occurs, and this new medication study adds one more reason not to skip them.
Tadalafil was linked to higher glaucoma and eye-pressure risk
The study, published in the British Journal of Ophthalmology, analyzed anonymized health data from 73,854 men age 40 and older.
Half had been prescribed tadalafil or another PDE5 inhibitor for up to five years to manage urinary symptoms linked to enlarged prostate. The other half had not received these medications.
The groups were matched for factors including age, ethnicity, smoking, cardiovascular disease, diabetes, obesity, kidney function and prescribed medications.
The findings were hard to ignore.
Men prescribed tadalafil were 22% more likely to develop glaucoma than men who had not been prescribed the drug.
They were also 32% more likely to develop ocular hypertension, or elevated pressure inside the eye.
And they were 33% more likely to develop primary open-angle glaucoma or begin glaucoma treatment.
The same general pattern held in additional analyses, including among men age 50 and older.
Does Cialis cause glaucoma?
Not necessarily.
This was an observational study, so it found a link but could not prove tadalafil caused glaucoma.
There may be other explanations, and researchers could not fully account for changes in medication use or new health conditions that developed during follow-up. Most participants were White, so the findings may not apply equally to all groups.
Even so, the researchers said chronic PDE5 inhibition may affect eye physiology and deserves further study.
Their recommendation was not to stop tadalafil. It was to consider baseline eye assessment and regular follow-up, especially for men who already have glaucoma risk factors or who require long-term therapy.
Who may need closer glaucoma monitoring
If a man is taking tadalafil daily for enlarged prostate symptoms, he may want to ask two doctors the same question: his prescribing doctor and his eye doctor.
“Do I need glaucoma monitoring because of this medication?”
That may matter even more for men who already have elevated eye pressure, glaucoma, a family history of glaucoma, high myopia or who require long-term tadalafil therapy.
Other risks can increase with age, diabetes and vascular problems. That’s one reason routine screening matters so much.
In fact, in our article on medical tests to expect in your 60s and beyond, vision testing belongs on the list because aging raises the risk of glaucoma, cataracts, macular degeneration and diabetic retinopathy.
The more risk factors you have, the less sense it makes to wait for symptoms.
Because with glaucoma, symptoms may arrive late.
Why a baseline eye exam can matter
If you take tadalafil every day for BPH, make sure your eye doctor knows it.
And if you already see an ophthalmologist for glaucoma or elevated eye pressure, make sure the doctor treating your prostate symptoms knows that too.
A baseline eye exam gives your eye doctor something to compare with later if eye pressure or optic nerve changes develop.
That can be especially useful when a medication is taken for years rather than occasionally.
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Don’t trade one problem for another
None of this means tadalafil is “bad.”
For some men, it may improve urinary symptoms, sexual function and quality of life.
We’ve also covered prostate warning signs men shouldn’t ignore, because urinary changes can be easy to minimize until they become harder to manage.
The point is not to avoid treatment.
The point is to treat the whole man.
If tadalafil is helping, that matters. But so does protecting vision.
So if you or someone you love takes tadalafil regularly, don’t stop the medication on your own. Instead, ask whether a comprehensive dilated eye exam makes sense now, and how often it should be repeated.
Also make sure your eye doctor knows what medications you take — not just eye drops, but prescriptions for prostate symptoms, sexual health, blood pressure, heart disease and diabetes.
And sometimes protecting your vision starts with a conversation you didn’t know you needed to have.
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Sources:
Cialis linked to higher glaucoma risk in large study — ScienceDaily
Risk of glaucoma among patients using tadalafil for lower urinary tract symptoms: a multinational cohort study — British Journal of Ophthalmology
Glaucoma — National Eye Institute
Glaucoma and Eye Pressure — National Eye Institute
Get a Dilated Eye Exam — National Eye Institute
Tadalafil Drug Information — MedlinePlus
FAQ: Cialis, glaucoma and eye monitoring: What to know
What medication was linked to glaucoma risk?
The study focused on tadalafil, best known by the brand name Cialis, when used long-term for lower urinary tract symptoms related to enlarged prostate. Tadalafil belongs to a drug class called PDE5 inhibitors. The study did not prove causation, but tadalafil use was associated with higher glaucoma-related risk.
How much higher was the glaucoma risk?
Men prescribed tadalafil were 22 percent more likely to develop glaucoma than matched men who had not been prescribed the medication. They were also 32 percent more likely to develop ocular hypertension and 33 percent more likely to develop primary open-angle glaucoma or start glaucoma treatment.
Does this mean tadalafil causes glaucoma?
No. This was an observational study, so it can show an association but cannot prove tadalafil directly causes glaucoma. Other factors may have contributed. The researchers said more study is needed but suggested eye monitoring for long-term users, especially those with existing glaucoma risk factors.
Should men stop taking tadalafil?
No one should stop tadalafil or any prescription medication without talking to their healthcare provider. The researchers specifically said the findings do not contraindicate tadalafil use. Instead, they point to the importance of baseline eye assessment and regular follow-up for people taking it long-term.
Who should ask about glaucoma monitoring?
Men taking tadalafil regularly for enlarged prostate symptoms may want to ask about glaucoma monitoring, especially if they have existing glaucoma, ocular hypertension, a family history of glaucoma, high myopia or require long-term tadalafil therapy. A comprehensive eye exam can help detect glaucoma before noticeable vision loss occurs.
By Dr. Adria Schmedthorst
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