Statin users had less open-angle glaucoma and less treatment escalation

Design

Retrospective matched cohort, TriNetX database

Population

210,701 adults over 40; 29,598 with open-angle glaucoma

Primary outcome

Glaucoma incidence and treatment escalation

Effect

Incidence HR 0.85 (0.82-0.89); SLT HR 0.40 (0.36-0.44) at 5 years

This retrospective study used the TriNetX database. The incidence analysis matched 210,701 adults over 40 who had seen an eye doctor in the previous year, comparing statin users with non-users. The treatment analysis included 29,598 people with glaucoma.

At five years, statin use was associated with a lower risk of developing open-angle glaucoma (HR 0.85, 95% CI 0.82 to 0.89) and fewer new glaucoma drop prescriptions (HR 0.89). Among people with glaucoma, statin users less often progressed to incisional surgery (HR 0.64), minimally invasive glaucoma surgery (HR 0.45) or selective laser trabeculoplasty (HR 0.40). Findings were similar at ten years.

Statins could plausibly act on outflow or optic nerve perfusion, but database studies are prone to healthy-user effects: people who take statins regularly may also attend and adhere better. Treatment escalation also depends on access and surgeon preference. This is a hypothesis for a trial, not a reason to prescribe a statin for glaucoma.

• Do not start a statin to prevent or treat glaucoma on this evidence.
• Record systemic medicines, including statins, at each glaucoma review.
• Avoid advising patients to stop a statin prescribed for cardiovascular reasons.
• Watch for trials testing statins in glaucoma before changing practice.

Why it matters

If confirmed, a common cardiovascular drug could slow a blinding disease, which is worth testing.

Don't overread it

A retrospective database study; healthy-user bias and differences in access could explain the association.

The statistics, in plain English

A hazard ratio of 0.85 means about 15% fewer new diagnoses over time among statin users. The large size gives narrow intervals, but precision does not remove bias from who takes a statin.

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