Statin users had less glaucoma and less escalation to surgery or laser

Design

Retrospective matched cohort, TriNetX database

Population

210,701 matched adults over 40 (incidence) and 29,598 with glaucoma (treatment)

Primary outcome

Open-angle glaucoma incidence and treatment escalation

Effect

5-year incidence HR 0.85 (0.82 to 0.89); SLT HR 0.40 (0.36 to 0.44)

A retrospective cohort using the TriNetX network matched 210,701 people over 40 with and without statin use, and separately 29,598 people with glaucoma.

At five years, statin use was associated with lower incidence of open-angle glaucoma (HR 0.85, 95% CI 0.82 to 0.89) and less escalation to incisional surgery (HR 0.64), minimally invasive glaucoma surgery (0.45) and selective laser trabeculoplasty (0.40). Associations persisted at 10 years.

The size of the escalation associations, larger than for incidence, is a warning sign: people who take statins regularly may differ in access to care, adherence and surgical referral patterns. This is hypothesis-generating; no trial has tested statins for glaucoma.

• Do not start a statin to prevent or treat glaucoma on this evidence.
• Record statin use in glaucoma patients; it may become relevant if trials confirm a benefit.
• Continue to manage glaucoma by intraocular pressure target and progression, as now.
• Reassure patients who take statins for cardiovascular reasons that there is no signal of harm to the eye.

Why it matters

A widely used, cheap drug with a consistent association is worth a randomised test.

Don't overread it

Observational database study; healthy-user effects may explain much of the association.

The statistics, in plain English

A hazard ratio of 0.85 means glaucoma was diagnosed about 15% less often over time in statin users. Larger apparent effects on surgery and laser (HR 0.40 to 0.64) are more likely to reflect differences in who receives those treatments than a drug effect.

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