GLP-1 Therapy Shows Promise for Glaucoma Risk Reduction
New real-world evidence suggests tirzepatide may be associated with lower glaucoma risk compared with other GLP-1 drugs in people with type 2 diabetes
In a large U.S. retrospective cohort study, patients with type 2 diabetes who used the dual GIP and GLP-1 drug tirzepatide had about half the risk of developing primary open-angle glaucoma compared with those using standard GLP-1 receptor agonists, although experts caution this finding should not change prescribing practices yet.
Study Details
Glaucoma is a leading cause of irreversible vision loss worldwide, often progressing slowly and without symptoms until significant damage has occurred. While elevated intraocular pressure is a key risk factor, glaucoma is increasingly understood as a neurodegenerative disease influenced by vascular health, metabolic stress, and inflammation.
GLP-1 receptor agonists are widely used to treat type 2 diabetes and obesity. Prior studies have hinted that these drugs may be linked to lower glaucoma risk compared with other weight-loss medications. This new analysis extends that idea by directly comparing tirzepatide, a dual GIP and GLP-1 drug, with traditional GLP-1 receptor agonists.
Methodology
Researchers analyzed electronic health record data from 71 U.S. healthcare organizations. They identified adults with type 2 diabetes who initiated tirzepatide or a selective GLP-1 receptor agonist between June 2022 and May 2025.
Using propensity score matching, the team created two well-balanced cohorts of 41,849 patients each. Participants were followed for new diagnoses of primary open-angle glaucoma or ocular hypertension and for initiation of glaucoma treatments, based on ICD-10 codes and prescription or procedure records.
Key Findings
Tirzepatide use was associated with a lower risk of primary open-angle glaucoma compared with GLP-1 receptor agonists, with a relative risk of 0.50
Risk of ocular hypertension was also lower among tirzepatide users, with a relative risk of 0.59
The need for glaucoma treatment, including medications or surgery, was reduced in the tirzepatide group, with a relative risk of 0.54
Absolute risk remained low, about 0.1 percent in the tirzepatide group versus 0.2 percent in the GLP-1 group
Results were consistent across subgroups, including patients using metformin or insulin and those aged 60 and older
Implications for Practice
For patients, these findings may be reassuring. If a GLP-1 based therapy is already appropriate for diabetes or obesity, tirzepatide could offer an additional potential eye-health benefit. However, the absolute risk reduction is small, and glaucoma remains a chronic disease that requires long-term monitoring and established treatments.
For clinicians, the study reinforces the idea that metabolic therapies may influence eye health beyond blood sugar and weight control. Possible mechanisms include improved vascular function, reduced metabolic stress on ocular tissues, enhanced insulin sensitivity, and neuroprotective signaling in retinal ganglion cells.
At the same time, experts stress caution. The study was retrospective, relied on diagnostic codes rather than direct eye exam data, and had relatively short follow-up. Tirzepatide should not be prescribed as a glaucoma treatment, and it should not replace proven therapies such as pressure-lowering eye drops or surgery. Longer studies with detailed ophthalmic measurements are needed before these findings can inform clinical guidelines.