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Glaucoma Risk Reduction as a Secondary Benefit of Glucagon-like Peptide-1 Receptor Agonists: A Review of Emerging
Mary V Lang1, Pranav Vasu2, Emily A Dorairaj3
1Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States.
Purpose:
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for type 2 diabetes (T2D) and later adopted for weight loss, have demonstrated potential protection against the development of glaucoma in various peer-reviewed publications. This review provides a synthesis of the emerging evidence evaluating the link between GLP-1 RA treatment and glaucoma risk.
Methods:
We performed a comprehensive literature search across PubMed, Embase (via OVID), and Scopus on May 28, 2025. Studies were included if they examined the association between GLP-1 RA use and glaucoma risk and presented novel quantitative data published in the last 6 years. Exclusion criteria included studies unrelated to glaucoma, those not evaluating GLP-1 RAs, and reviews without original data.
Results:
Of the 44 studies identified, 9 met inclusion criteria: 5 retrospective observational studies, 1 nested case-control study, 1 preclinical study, 1 systematic review and meta-analysis, and 1 Mendelian randomization study. Most studies found a statistically significant association between GLP-1 RA use and reduced glaucoma risk, with stronger effects observed with prolonged exposure in three studies. One preclinical study demonstrated that the GLP-1 RA NLY01 mitigated retinal neuroinflammation and protected ganglion cells in a mouse model. Proposed mechanisms include intraocular pressure (IOP) reduction, attenuation of oxidative stress, and direct neuroprotection via GLP-1 receptor activation. However, one Mendelian randomization study did not support a causal link.
Conclusions:
Current evidence suggests that GLP-1 RAs may confer a secondary benefit in reducing glaucoma risk, supported by both clinical and preclinical data. However, the predominance of retrospective studies, coupled with the lack of randomized controlled trials, limit causal inference. Further randomized controlled trials and mechanistic investigations are warranted to validate these findings and assess their translational potential in glaucoma prevention.
How To Cite This Article:
Lang MV, Vasu P, Dorairaj EA, et al. Glaucoma Risk Reduction as a Secondary Benefit of Glucagon-like Peptide-1 Receptor Agonists: A Review of Emerging Evidence. J Curr Glaucoma Pract 2025;19(4):223-228.
Insights
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may reduce glaucoma risk, according to emerging clinical and preclinical evidence. Further research, including randomized controlled trials, is needed to confirm these findings and explore their potential for glaucoma prevention.
Area of Science:
- Ophthalmology
- Endocrinology
- Pharmacology
Background:
- Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are established treatments for type 2 diabetes and obesity.
- Emerging research suggests a potential protective role of GLP-1 RAs against glaucoma development.
- This review synthesizes current evidence on the association between GLP-1 RA treatment and glaucoma risk.
Purpose of the Study:
- To review and synthesize the emerging evidence linking GLP-1 receptor agonist (GLP-1 RA) treatment to glaucoma risk.
- To evaluate the potential of GLP-1 RAs as a secondary benefit in reducing glaucoma incidence or progression.
Main Methods:
- Comprehensive literature search conducted on PubMed, Embase, and Scopus up to May 28, 2025.
- Inclusion criteria focused on studies examining GLP-1 RA use and glaucoma risk with novel quantitative data from the last 6 years.
- Exclusion of studies unrelated to glaucoma, those not evaluating GLP-1 RAs, and reviews lacking original data.
Main Results:
- Nine studies met inclusion criteria, including observational, preclinical, and meta-analysis studies.
- Most studies indicated a statistically significant association between GLP-1 RA use and reduced glaucoma risk.
- Preclinical data showed GLP-1 RAs may mitigate retinal neuroinflammation and protect ganglion cells; proposed mechanisms include IOP reduction, reduced oxidative stress, and direct neuroprotection.
Conclusions:
- GLP-1 RAs may offer a secondary benefit in reducing glaucoma risk, supported by clinical and preclinical data.
- The current evidence base, predominantly retrospective, limits definitive causal inference.
- Further randomized controlled trials and mechanistic studies are essential to validate findings and assess translational potential for glaucoma prevention.
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