TOPLINE:

Patients with type 2 diabetes who used tirzepatide had a 50% lower risk of developing primary open-angle glaucoma, a 41% lower risk of developing elevated eye pressure, and a 46% lower risk of initiating glaucoma treatments than those who used GLP-1 receptor agonists.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to assess whether initiating tirzepatide, an incretin-based therapy, was linked to outcomes related to glaucoma in patients with type 2 diabetes.
• They analyzed records from 71 healthcare organizations in the US and identified patients who initiated either tirzepatide or selective GLP-1s between June 2022 and May 2025. GLP-1 drugs included semaglutide, dulaglutide, liraglutide, lixisenatide, and exenatide.
• After propensity score matching, the final analysis included 41,849 users each of tirzepatide and GLP-1s (mean age, 55.1 years in both groups; 56.9% and 57.5% women, respectively).
• The primary outcome was a new diagnosis of primary open-angle glaucoma. Secondary outcomes were the occurrence of ocular hypertension and the initiation of glaucoma treatment, either using medications or surgery.
• The mean follow-up duration was 1.4 years for users of tirzepatide and 1.5 years for users of GLP-1 agents.

TAKEAWAY:

• Users of tirzepatide were less likely to develop primary open-angle glaucoma (risk ratio [RR], 0.50; 95% CI, 0.34-0.74), ocular hypertension (RR, 0.59; 95% CI, 0.40-0.88), and initiation of glaucoma treatment (RR, 0.54; 95% CI, 0.45-0.64) than patients taking GLP-1 receptor agonists.
• Among patients taking metformin or insulin, users of tirzepatide had 33%-52% lower risks for primary open-angle glaucoma, ocular hypertension, or glaucoma treatments than users of GLP-1 drugs.
• Among patients aged 60 years or older, the use of tirzepatide maintained lower risks for primary open-angle glaucoma (RR, 0.52; 95% CI, 0.32-0.84) and initiation of glaucoma treatment (RR, 0.58; 95% CI, 0.48-0.70).
• The use of tirzepatide was associated with a 41% lower risk for primary open-angle glaucoma and a 33% lower risk of initiating glaucoma treatment than the use of semaglutide. Similar reductions were noted when tirzepatide was compared with dulaglutide.

IN PRACTICE:

“The observed ocular benefits may be attributable to tirzepatide’s superior metabolic effects, along with potential neuroprotective properties mediated by” the drug’s activation of both glucose-dependent insulinotropic polypeptide and GLP-1 receptors, the researchers wrote.

“Rather than a drug-specific anomaly, these trends point to a broader therapeutic role for incretin-based therapies in ocular health, with tirzepatide potentially amplifying this benefit,” they added.

SOURCE:

This study was led by Alexander T. Hong, BS, of the Keck School of Medicine of University of Southern California in Los Angeles. It was published online on December 5, 2025, in the American Journal of Ophthalmology.

LIMITATIONS:

Certain unmeasured factors may have affected the results but could not be accounted for. Relying on diagnostic codes may have misclassified glaucoma and related conditions. The short follow-up duration may not have captured long-term development of glaucoma.

DISCLOSURES:

This study received funding from Research to Prevent Blindness, New York City. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.