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Metformin Use and Risk of Glaucoma: A Systematic Review and Meta-Analysis.

Abdelaziz Abdelaal1, Hashem Abu Serhan2, Mustafa Alsaadi3

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Metformin use showed no association with reduced glaucoma risk in initial analyses. However, time-to-event data consistently indicated a modest risk reduction, suggesting a potential protective effect for glaucoma prevention.

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Area of Science:

  • Ophthalmology
  • Endocrinology
  • Pharmacology

Background:

  • Glaucoma is a leading cause of irreversible blindness globally.
  • Patients with diabetes are frequently treated with metformin and are at increased risk for glaucoma.
  • Identifying medications that may modify glaucoma risk is crucial for prevention strategies.

Purpose of the Study:

  • To evaluate the association between metformin use and the risk of developing glaucoma.
  • To synthesize evidence from observational cohort studies through a systematic review and meta-analysis.

Main Methods:

  • Systematic review and meta-analysis of 12 observational cohort studies (n=1,247,325).
  • Searched PubMed, Scopus, Web of Science, and Google Scholar.
  • Analyzed binary outcomes using random-effects models (Odds Ratios) and time-to-event outcomes using Hazard Ratios; assessed risk of bias and certainty of evidence.

Main Results:

  • Crude analyses showed no significant association between metformin and glaucoma risk (OR=0.96).
  • Sensitivity analyses excluding non-metformin comparators suggested a modest risk reduction (OR=0.92).
  • Time-to-event analyses consistently demonstrated a modest glaucoma risk reduction (adjusted HR=0.88) with moderate certainty.

Conclusions:

  • Metformin use was not associated with reduced glaucoma risk in crude observational analyses.
  • Time-to-event analyses suggest a consistent, modest protective effect of metformin against glaucoma.
  • The certainty of evidence varied, being moderate for time-to-event analyses but very low for comparator analyses.