Which medication is associated with a myopic shift and potential angle-closure glaucoma?

• A. Latanoprost
• B. Timolol
• C. Prednisolone
• D. Topamax

Answer: (D)

Topiramate (Topamax) is known to cause a sudden myopic shift with the risk of secondary angle-closure glaucoma. The mechanism involves ciliochoroidal effusion that pushes the lens-iris diaphragm forward, leading to a shallower anterior chamber and narrowing or occlusion of the angle. This typically appears within days to weeks after starting the medication and can reverse when the drug is stopped. Clinically, patients may report acute blurred vision, halos, headache, and eye discomfort.

The other medications listed do not typically cause this combination. Latanoprost is a prostaglandin analog mainly associated with outflow changes and rarely with myopic shift or acute angle closure. Timolol lowers IOP without causing forward movement of the lens-iris apparatus. Prednisolone can raise IOP in steroid responders but does not typically produce the myopic shift with acute angle-closure mechanism described here.