Ocular changes in patients on Topiramate therapy: a hospital-based comparative study

To evaluate the effect of newly administered Topiramate therapy on various ophthalmological parameters. This was a hospital-based, prospective, non-randomized, longitudinal, comparative study conducted in the Department of Ophthalmology at a tertiary care hospital from August 2024 to March 2025. Patients aged between 18 and 40 years, and newly initiated on Topiramate therapy by the department of Neurology, were recruited in the study and constituted the study group. Age- and gender-matched healthy individuals constituted the control group. A comprehensive ophthalmic evaluation was done in every case. Ocular parameters studied were intraocular pressure (IOP), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), and peripapillary retinal nerve fiber layer (RNFL) thickness. Assessment was performed at baseline and at 15 days, 1 month, and 3 months following Topiramate therapy. A total of 160 eyes of 80 patients (40 patients newly initiated on Topiramate therapy and 40 healthy controls) were analyzed in the study. The mean age was 30.27 ± 4.83 years and 30.7 ± 4.6 years, respectively, in both groups. Significant increases were observed in IOP (from 13.46 ± 1.71 mm Hg to 18.18 ± 2.48 mm Hg, P < 0.001), CCT (from 516.76 ± 34.58 μm to 524.38 ± 36.04 μm, P < 0.001), LT (from 3.81 ± 0.33 mm to 3.85 ± 0.33 mm, P < 0.001), and peripapillary RNFL thickness (P < 0.001 in all quadrants). ACD showed a significant reduction over time (P < 0.001), and a progressive myopic shift was noted (-0.20 ± 0.39 D to -0.37 ± 0.33 D, P < 0.001). The findings of the present study highlight the need for routine ophthalmic evaluations in patients on Topiramate to detect early changes and prevent vision-threatening complications. Given the progressive nature of these alterations, early intervention and close monitoring are crucial for patient safety.