- A retrospective study suggested that use of the dual GIP/GLP-1 drug tirzepatide was associated with a significantly reduced risk of glaucoma compared with GLP-1 drugs among patients with type 2 diabetes.
- Prior research has suggested that use of GLP-1 receptor agonists for obesity was associated with a reduced risk of glaucoma compared with other weight-loss medications.
- Use of tirzepatide was also tied to a significantly reduced risk of ocular hypertension and the need for glaucoma treatment.
Use of the dual GIP/GLP-1 drug tirzepatide (Mounjaro, Zepbound) was associated with a significantly reduced risk of glaucoma compared with GLP-1 drugs among patients with type 2 diabetes, a large retrospective cohort study suggested.
In matched cohorts of more than 41,000 patients each, use of tirzepatide was linked to a significantly reduced risk of primary open-angle glaucoma compared with selective GLP-1 receptor agonists (risk ratio [RR] 0.50, 95% CI 0.34-0.74), reported Robert N. Weinreb, MD, of the University of California San Diego, and colleagues.
The dual drug was also tied to a significantly reduced risk of ocular hypertension (RR 0.59, 95% CI 0.40-0.88) and the need for glaucoma treatment (RR 0.54, 95% CI 0.45-0.64), they noted in the American Journal of Ophthalmology.
Weinreb said that the absolute risk of primary open-angle glaucoma was about 0.1% in the tirzepatide group and about 0.2% in the GLP-1 group.
“In a patient with glaucoma or suspected glaucoma for whom a GLP-1-based therapy is already indicated, or someone with an elevated glaucoma risk, a clinician might consider tirzepatide,” Weinreb told MedPage Today.
“These drugs seem to be protective against whatever you look at,” he added. “It’s really remarkable, isn’t it?”
A previous retrospective cohort study also suggested that use of GLP-1 receptor agonists for obesity was associated with a reduced risk of primary open-angle glaucoma and ocular hypertension compared with other weight-loss medications.
The study by Weinreb and colleagues is unique because it compares a dual GIP/GLP-1 drug with GLP-1 drugs. Weinreb said his team launched the study in light of findings that linked tirzepatide to more weight loss and blood sugar control than its rivals.
It is unclear why tirzepatide in particular and GLP-1 drugs in general appear to be protective against glaucoma, he noted. The beneficial effect, he speculated, could be due to enhancement of vascular function, reduction of metabolic stress on ocular tissues, or improvement of insulin sensitivity.
“These drugs are also involved in neuroprotective signaling, so they might be protecting the nerve fibers in the retinal ganglion cells independent of intraocular pressure,” he said.
Andrew Morgenstern, OD, of Walter Reed National Military Medical Center in Bethesda, Maryland, who was not involved in the study, told MedPage Today that the findings aren’t surprising, although they need to be validated.
He emphasized that tirzepatide should not be viewed as a primary glaucoma treatment. “I don’t think there’s a reputable eye doctor out there who would take a patient that’s at high risk for glaucoma, or has glaucoma, and say, ‘Let’s use a GLP-1 receptor agonist as the drug choice for this patient to be the primary treatment of their glaucoma,'” Morgenstern said.
Abhimanyu Ahuja, MD, of the Casey Eye Institute at Oregon Health & Science University in Portland, who led a recent study on the effects of GLP-1 drugs on age-related macular degeneration (AMD), told MedPage Today that while the new findings are thought-provoking, they’re based on a short follow-up period while “glaucoma is a chronic, slowly progressive disease.”
For this study, Weinreb and colleagues used data from 71 U.S. healthcare organizations to identify patients who started tirzepatide or a GLP-1 drug from June 2022 to May 2025 and compared propensity score-matched groups of 41,849 patients.
Across both groups, mean age was 55, 57% were women, 71% were white, 14% were Black or African American, 8% were Hispanic or Latino, and 3% were Asian. A majority of both groups had essential hypertension (66-67%), 49-50% had hyperlipidemia, and 10% had chronic kidney disease. Similar proportions of patients were taking insulin (29-30%), metformin (56%), systemic beta-blockers (38-39%), statins (57%), and systemic corticosteroids (64-65%).
Outcomes of interest were new ICD-10 diagnosis codes for primary open-angle glaucoma and ocular hypertension and initiation of first-line glaucoma treatments including medications and surgeries.
Risk reductions persisted in subgroups with concomitant metformin or insulin use, the authors noted. Sensitivity analyses for patients ages 60 and older and comparisons with individual GLP-1 drugs, such as semaglutide (Ozempic, Wegovy) and dulaglutide (Trulicity), showed consistent trends.
Limitations included the propensity score-matched study design, reliance on ICD-10 codes, and the short follow-up period.
As for future research, Alfredo Paredes III, a medical student at Florida Atlantic University in Boca Raton, who co-authored the AMD study, told MedPage Today that studies are needed with longer follow-up and eye-exam data such as intraocular pressure measurements and visual field findings rather than just ICD-10 codes.
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