Autores
Jawad Muayad, BSc¹; Asad Loya, MD²; Zain S. Hussain, BSc³; Muhammad Z. Chauhan, MD, MS⁴; Amer F. Alsoudi, MD²; Ticiana De Francesco, MD⁵˒⁶˒⁷; Iqbal Ike K. Ahmed, MD⁵˒⁸˒⁹.
Purpose
To compare the effects of glucagon-like peptide 1 (GLP-1) receptor agonists and metformin on the risk of primary open-angle glaucoma (POAG), ocular hypertension, and the need for first-line glaucoma treatments in patients with type 2 diabetes mellitus (T2DM).
Design
Retrospective cohort study using electronic medical record data from an international electronic health record network covering the period from May 2006 to 2024.
Participants
Patients diagnosed with T2DM who were treated with either GLP-1 receptor agonists or metformin.
Methods
Data from 120 health care organizations across 17 countries were analyzed. Patient outcomes were assessed at 1, 2, and 3 years after treatment initiation.
Propensity score matching (PSM) was used to balance relevant covariates, including demographic characteristics, comorbidities, and medication use. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to compare outcomes between the treatment groups.
Main Outcome Measures
The primary outcomes included the incidence of primary open-angle glaucoma, ocular hypertension, and the need for first-line glaucoma treatments, including topical medications and laser trabeculoplasty.
Results
After propensity score matching, both treatment groups included 61,998 patients at the 1-year follow-up, 27,414 patients at the 2-year follow-up, and 14,100 patients at the 3-year follow-up.
Patients treated with GLP-1 receptor agonists demonstrated a significantly lower risk of developing primary open-angle glaucoma compared with patients receiving metformin. The risk reduction was observed at 1 year (RR, 0.59; 95% CI, 0.39–0.88), 2 years (RR, 0.50; 95% CI, 0.32–0.78), and 3 years (RR, 0.59; 95% CI, 0.37–0.94).
Similar protective associations were observed for ocular hypertension. Compared with metformin, GLP-1 receptor agonists were associated with a lower risk of ocular hypertension at 1 year (RR, 0.44; 95% CI, 0.31–0.62), 2 years (RR, 0.43; 95% CI, 0.30–0.62), and 3 years (RR, 0.51; 95% CI, 0.34–0.75).
The risk of initiating first-line glaucoma therapy was also lower among patients receiving GLP-1 receptor agonists. The corresponding risk ratios were 0.63 (95% CI, 0.53–0.74) at 1 year, 0.71 (95% CI, 0.59–0.85) at 2 years, and 0.75 (95% CI, 0.62–0.91) at 3 years.
Conclusions
Glucagon-like peptide 1 receptor agonists were associated with a significantly lower incidence of primary open-angle glaucoma, ocular hypertension, and the need for first-line glaucoma treatments compared with metformin in patients with type 2 diabetes mellitus.
These findings suggest a potential association between GLP-1 receptor agonist therapy and ocular benefits in patients with diabetes and highlight the possible expanding role of these medications in the clinical management of patients at risk of glaucoma.
Financial Disclosure
Proprietary or commercial disclosures may be found in the Footnotes and Disclosures section of the original publication.
Referência
Ophthalmology. 2025;132:271–279. © 2024 by the American Academy of Ophthalmology.