Statin use was associated with lower open-angle glaucoma incidence and fewer glaucoma procedures

Design

Retrospective cohort, TriNetX database, propensity matched

Population

210,701 matched adults over 40 (incidence analysis); 29,598 matched patients with glaucoma (treatment analysis)

Primary outcome

Open-angle glaucoma onset and escalation to ocular hypotensive treatment or procedures

Effect

5-year incidence HR 0.85 (95% CI 0.82 to 0.89); incisional surgery HR 0.64 (0.58 to 0.71); MIGS HR 0.45; SLT HR 0.40

This retrospective cohort study used the TriNetX database. The incidence analysis matched 210,701 adults over 40 with ophthalmological follow-up, comparing statin users with non-users, and the treatment analysis matched 29,598 people who already had glaucoma.

At five years, statin use was associated with lower open-angle glaucoma incidence (HR 0.85, 95% CI 0.82 to 0.89), with similar results at ten years (HR 0.90, 0.87 to 0.93). Among people with glaucoma, statin use was associated with a lower hazard of escalation to incisional surgery (HR 0.64 at five years), minimally invasive glaucoma surgery (HR 0.45) and selective laser trabeculoplasty (HR 0.40), and with less topical ocular hypotensive prescribing (HR 0.89).

The effects on procedures are far larger than the effect on incidence, which raises the possibility of detection and treatment-pattern differences, such as people on statins being seen differently or having different thresholds for procedures. The authors call for prospective trials. Statins should be prescribed for their established cardiovascular indications, not for glaucoma.

• Statin users had lower 5-year open-angle glaucoma incidence (HR 0.85, 95% CI 0.82 to 0.89).
• Among people with glaucoma, statin use was linked to fewer laser, MIGS and incisional procedures.
• The procedure hazard ratios (0.40 to 0.64) are strikingly large and may reflect confounding.
• Do not start a statin for glaucoma on the basis of this study.
• Note statin use when assessing glaucoma risk, without altering follow-up intervals.

Why it matters

It raises a testable question about a widely used drug but cannot answer it.

Don't overread it

This is a retrospective database association; it does not show that statins prevent glaucoma or slow its treatment needs.

The statistics, in plain English

A hazard ratio of 0.85 means a 15% lower rate of new glaucoma over five years in matched statin users. Matching balances the factors measured, but not unmeasured ones such as healthcare access or eye-clinic attendance, which could easily produce differences of this size in a database study.

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