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Protective Role of Metformin in Glaucoma: Prospective Cohort Study, Meta-Analysis, and Drug-Target Mendelian
Can Can Xue1, Hengtong Li2,3, Miao Li Chee1
1Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
Ophthalmology Science
|March 12, 2026
Summary
Metformin use may protect against glaucoma in diabetic patients. This finding, supported by cohort, meta-analysis, and genetic studies, suggests metformin could be a potential preventive therapy.
Area of Science:
- Ophthalmology
- Endocrinology
- Pharmacology
Background:
- Preclinical studies suggest metformin's protective mechanisms against glaucoma.
- Observational studies have yielded mixed results regarding metformin and glaucoma risk.
- Clarifying the association requires robust analytical approaches.
Purpose of the Study:
- To investigate the association between metformin use and glaucoma incidence.
- To synthesize existing evidence through meta-analysis.
- To explore potential causal links using drug-target Mendelian randomization (MR).
Main Methods:
- Prospective cohort study of 24,206 UK Biobank participants with diabetes.
- Multivariable Cox regression for incident glaucoma analysis.
- Random-effect meta-analysis and drug-target MR analysis using genetic variants for metformin targets.
Main Results:
- Metformin use was associated with a 19% lower glaucoma risk in the cohort.
- Meta-analysis confirmed a protective effect (pooled risk ratio, 0.81).
- Genetically proxied metformin targets showed a 34% lower glaucoma risk.
Conclusions:
- Convergent evidence supports metformin's protective association with glaucoma in diabetic patients.
- Findings suggest metformin as a potential preventive glaucoma therapy.
- Randomized clinical trials are warranted to confirm these results.
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