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Editors Selection IGR 26-1
Glaucoma and Systemic Diseases: GLP-1 agonists may protect against glaucoma even without diabetes
Comment by Tony Realini on:
125344 Risk of Glaucoma in Patients without Diabetes Using a Glucagon-Like Peptide 1 Receptor Agonist, Vasu P; Dorairaj EA; Dorairaj EA; Weinreb RN et al., Ophthalmology, 2025; 0:
Glucagon-like peptide 1 receptor agonists (GLP-1s) have been immensely impactful in the management of diabetes mellitus, and more recently have revolutionized weight loss for countless millions of overweight and obese patients with and without diabetes. There is a small population of GLP-1 receptor-positive cells in the human retinal ganglion cell layer. In animal models, GLP-1s exert a neuroprotective effect and may also lower intraocular pressure. Subsequently, early epidemiologic data suggest that GLP-1 use may significantly reduce the risk of developing glaucoma. To more robustly explore this intriguing potential effect of GLP-1 drugs, Vasu and colleagues conducted a retrospective cohort study in over 61,000 overweight or obese non-diabetic patients taking GLP-1 drugs for weight loss versus alternative weight loss therapies to assess the risk of subsequently being diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). After propensity score matching to balance demographics, comorbidities, and other medication use, the relative risk of developing POAG or OHT was markedly lower in the GLP-1 group versus the alternative weight loss group. At 3 and 5 years of follow-up, the risk ratio for developing glaucoma was 50.4% and 58.5%, respectively, indicating a 2-fold lower risk of developing POAG for those using GLP-1 drugs versus other weight loss therapies. For OHT, the 3- and 5-year risk ratios were 55.9% and 65.8%, respectively, further supporting the positive effect of GLP-1 therapy in preventing OHT and POAG. While the study cannot account for the potential confounding effects of greater weight loss in the GLP-1 group, these results are of immense significance for two reasons: 1) these drugs are already developed, tested, approved, available, and very well tolerated; and 2) the effect size—the extent of glaucoma risk reduction seen with their use—was extraordinary. If these results hold in future robust studies, as many as half of all new cases of POAG and OHTN could be prevented or delayed by 5 years or more. While it is unlikely that prevention of glaucoma would ever be a motivational indication for taking lifelong therapy with these drugs, the ever-expanding list of other health benefits of GLP-1 drugs—not just weight loss, but reduced risk of stroke, myocardial infarction, pulmonary embolism, and death—could easily become a reason for widespread prophylactic use with glaucoma prevention being a secondary benefit.
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