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

Feb 20, 2025Ophthalmology

Glaucoma risk in non-diabetic patients using a diabetes-related medication

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Abstract

The risk of primary open-angle glaucoma (POAG) was 50.4% lower in patients taking glucagon-like peptide 1 receptor agonists (GLP-1RAs) compared to those using alternative weight loss medications at 3 years.

Both POAG and ocular hypertension risks were significantly lower in the GLP-1RA group at 3 and 5 years of follow-up.
At 3 years, the risk of developing POAG was reduced by 50.4% in the GLP-1RA group.
At 5 years, the risk of developing POAG was reduced by 58.5% in the GLP-1RA group.
At 3 years, the risk of developing ocular hypertension was reduced by 55.9% in the GLP-1RA group.
At 5 years, the risk of developing ocular hypertension was reduced by 65.8% in the GLP-1RA group.

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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.

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

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