GLP-1RAs cut risk of cataract, AMD, glaucoma, and dry eye by 33-55% in non-diabetic obese adults

Age-related ocular diseases like cataract, age-related macular degeneration (AMD), and glaucoma are leading causes of vision impairment and blindness, particularly in older adults. Current interventions are often reactive, focusing on slowing progression or surgical correction, with limited preventative pharmacological options. Given the increasing prevalence of obesity and its association with systemic inflammation and metabolic dysfunction, which can impact ocular health, there's a critical need for preventative strategies. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), primarily known for their metabolic benefits in type 2 diabetes and obesity, have shown anti-inflammatory and neuroprotective properties, suggesting a potential role in protecting against ocular pathologies by modulating pathways like NF-κB or mTORC1.

Researchers conducted a retrospective, propensity score-matched cohort study using the TriNetX global research network. They enrolled 68,536 non-diabetic, overweight or obese adults aged ≥60 years with no prior ophthalmic disease at baseline. Patients receiving liraglutide or semaglutide were matched 1:1 with users of alternative weight-loss medications, including bupropion-naltrexone, phentermine-topiramate, setmelanotide, or orlistat. The primary outcomes assessed were the up to 5-year risks of incident cataract, age-related macular degeneration (AMD), ocular hypertension, primary open-angle glaucoma (POAG), and dry eye syndrome (DES), identified via ICD-10 codes.

GLP-1RA use was significantly associated with a lower 5-year risk across all assessed age-related ocular diseases. The risk of incident cataract was reduced by 55% (RR: 0.45; 95% CI, 0.40-0.50). For AMD, the risk was 67% lower (RR: 0.33; 95% CI, 0.23-0.48). Ocular hypertension risk decreased by 44% (RR: 0.56; 95% CI, 0.34-0.91), and POAG risk was halved, showing a 50% reduction (RR: 0.50; 95% CI, 0.32-0.78). Dry eye syndrome (DES) risk saw a 64% decrease (RR: 0.36; 95% CI, 0.31-0.42). Sensitivity analyses further supported these findings, demonstrating consistent reductions across various cataract subtypes:

Nuclear cataracts were reduced by 58% (RR: 0.42; 95% CI, 0.37-0.48), cortical cataracts by 63% (RR: 0.37; 95% CI, 0.36-0.55), and posterior subcapsular cataracts by 52% (RR: 0.48; 95% CI, 0.26-0.91). Similar protective effects were observed for retinal hemorrhage or edema (RR: 0.44; 95% CI, 0.30-0.63) and the need for dry eye-related medication (RR: 0.44; 95% CI, 0.39-0.50), all indicating a broad ocular protective effect.