GLP-1 Receptor Agonists Show Promise in Glaucoma and Ocular Hypertension Treatment
A recent narrative review suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for diabetes management, may offer significant benefits in reducing the risk of ocular hypertension and glaucoma. While further research is needed, current findings indicate a neuroprotective and anti-inflammatory effect on the optic nerve and retinal ganglion cells.
GLP-1 RAs: Protective and Adverse Effects on the Eye
GLP-1 RAs appear to exert both protective and, potentially, adverse effects on the eye. The protective mechanisms involve improved retinal vascular regulation, reduced inflammatory signaling in retinal tissues, preservation of the blood-retinal barrier, and lowered vascular permeability. Though, vascular dysregulation secondary to metabolic shifts could lead to adverse ocular effects under certain conditions.
Review of Existing Studies
Researchers conducted a narrative review of 60 studies published between 2014 and 2025 to assess the impact of GLP-1 RAs on various ocular conditions, including diabetic retinopathy, diabetic macular edema, vitreous hemorrhage, nonarteritic anterior ischemic optic neuropathy, glaucoma/ocular hypertension, retinal vein occlusion, and idiopathic intracranial hypertension and papilledema.
Positive Findings for Glaucoma
The review revealed promising results regarding glaucoma. A retrospective cohort study demonstrated a significantly lower risk of glaucoma among patients using GLP-1 RAs, with 10 new cases compared to 58 in a control group (P = .01). A large cohort study indicated significantly reduced risks for ocular hypertension, primary open-angle glaucoma, and initiation of first-line glaucoma treatments. Specifically, patients on GLP-1 RAs had a 50% lower risk for primary open-angle glaucoma by the second year of treatment, and the incidence of ocular hypertension was substantially reduced at all measured time points.
A meta-analysis encompassing over 2.5 million participants showed a non-significant reduction in glaucoma incidence among those on GLP-1 RAs. However, GLP-1 RAs were associated with significantly better glaucoma outcomes (P = .01) compared to other diabetes medications.
Clinical Implications
The findings suggest that GLP-1 RAs may provide a neuroprotective and anti-inflammatory benefit for the optic nerve and retinal ganglion cells, in addition to their established metabolic effects. Researchers emphasize the importance of baseline ophthalmic evaluations, patient counseling regarding potential visual side effects, and close clinical follow-up when considering GLP-1 RAs for patients with or at risk of glaucoma.