Association between GLP-1 receptor agonist use and glaucoma risk: a systematic review and meta-analysis

Glaucoma is a leading cause of irreversible blindness despite adequate intraocular pressure control. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated neuroprotective effects in experimental models, but their association with glaucoma in clinical populations remains unclear.
We searched PubMed, Scopus, Web of Science, and Google Scholar up to 22 May 2025, for observational studies comparing incident glaucoma in GLP-1 RA users versus non-users. Studies reporting odds ratios (ORs) or hazard ratios (HRs) were included. Pooled estimates were calculated, with meta-regression and subgroup analyses exploring heterogeneity and potential effect modifiers.
Ten studies were analyzed (N = 486,969; GLP-1 RA: 62,522; controls: 424,447). The pooled incidence of glaucoma was 3.77% in GLP-1 RA users vs. 22.20% in controls (OR =0.89; 95%CI: 0.75–1.05; P = 0.160; I2 = 82.4%). Among five studies reporting adjusted HRs, the pooled estimate was 0.83 (95%CI: 0.62–1.04; P = 0.105; I2 = 87.6%). Subgroup analysis revealed a significant reduction in glaucoma risk at 48 months (OR =0.78; 95%CI: 0.66–0.91; P = 0.002). Exploratory meta-regression suggested a protective effect in older adults (P = 0.046) and hypertensive patients (P = 0.014).
GLP-1 RA use was not associated with a significant reduction in glaucoma risk. However, findings suggest potential benefit in older and hypertensive populations, warranting further investigation.