Risk of Glaucoma in Patients without Diabetes Using a Glucagon-Like Peptide 1 Receptor Agonist

Ophthalmology. 2025 Aug;132(8):859-868. doi: 10.1016/j.ophtha.2025.02.011. Epub 2025 Feb 18.

Abstract

Purpose: To compare the risk of primary open-angle glaucoma (POAG) and ocular hypertension in patients with obesity taking glucagon-like peptide 1 receptor agonists (GLP-1RAs) versus alternative weight loss medications.

Design: A retrospective cohort study of the TriNetX research network was conducted by analyzing international electronic health record data from January 2004 through December 2024.

Participants: Patients without diabetes who had a diagnosis of being overweight or obesity who were treated with either GLP-1RAs or alternative weight loss medications, including orlistat, phentermine-topiramate, bupropion-naltrexone, or setmelanotide.

Methods: Patients were assessed for outcomes at 3 and 5 years. Propensity score matching (PSM) was conducted between cohorts matched for baseline demographics, comorbidities, and medication use. Risk ratios (RR) and 95% confidence intervals (CIs) were calculated subsequently.

Main outcome measures: Risk of POAG and ocular hypertension.

Results: After PSM, both cohorts comprised 61 057 patients. The risk of both POAG and ocular hypertension were significantly lower in the GLP-1RA group at both 3 and 5 years of follow-up. A 50.4% lower risk at 3 years (RR, 0.496; 95% CI, 0.371-0.664) and a 58.5% lower risk at 5 years (RR, 0.415; 95% CI, 0.316-0.545) for POAG developing was noted. Lower risks of 55.9% at 3 years (RR, 0.441; 95% CI, 0.318-0.611) and 65.8% at 5 years (RR, 0.342; 95% CI, 0.250-0.466) for ocular hypertension developing were noted.

Conclusions: In patients without diabetes, the use of GLP-1RAs exhibited a significantly lower risk of POAG and ocular hypertension compared with alternative weight loss therapy at 3-year and 5-year intervals.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: GLP-1 receptor agonists; Ocular hypertension; Primary open-angle glaucoma; Propensity score matching; Weight loss.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Anti-Obesity Agents / therapeutic use
  • Female
  • Follow-Up Studies
  • Glaucoma, Open-Angle* / diagnosis
  • Glaucoma, Open-Angle* / epidemiology
  • Glaucoma, Open-Angle* / etiology
  • Glucagon-Like Peptide-1 Receptor Agonists*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Incidence
  • Intraocular Pressure / physiology
  • Male
  • Middle Aged
  • Obesity* / complications
  • Obesity* / drug therapy
  • Ocular Hypertension* / epidemiology
  • Propensity Score
  • Retrospective Studies
  • Risk Factors

Substances

  • Glucagon-Like Peptide-1 Receptor Agonists
  • Hypoglycemic Agents
  • Anti-Obesity Agents