TIRZEPATIDE glaucoma risk may be significantly lower than with selective glucagon-like peptide-1 receptor agonists, according to a large retrospective cohort study of adults with type 2 diabetes mellitus. The analysis found that initiation of tirzepatide was associated with reduced incidence of primary open-angle glaucoma, ocular hypertension, and the need for first-line glaucoma treatment when compared with selective glucagon-like peptide-1 receptor agonist therapy.
Study Design and Population
This retrospective clinical cohort study used data from a nationwide electronic health records network spanning June 2022–May 2025. Adults with type 2 diabetes mellitus who initiated either tirzepatide or a selective glucagon-like peptide-1 receptor agonist were included. Patients with prior exposure to either drug class, recent addition of second-line antihyperglycaemic therapy, existing glaucoma, prior glaucoma surgery, or ocular trauma were excluded. Data were drawn from 71 healthcare organisations across the United States. To reduce confounding, investigators applied one-to-one propensity score matching to balance demographics, comorbidities, medication use, and ophthalmic encounters between groups.
Tirzepatide Glaucoma Risk Outcomes
Following matching, 41,849 patients remained in each cohort. Tirzepatide initiation was associated with a lower risk of primary open-angle glaucoma compared with selective glucagon-like peptide-1 receptor agonists: risk ratio: 0.50; 95% CI: 0.34–0.74. A similar pattern was observed for ocular hypertension: risk ratio: 0.59; 95% CI: 0.40–0.88. The need for first-line glaucoma treatment, including medication or surgery, was also reduced: risk ratio: 0.54; 95% CI: 0.45–0.64. Risk reductions remained consistent among patients using concomitant metformin or insulin.
Sensitivity Analyses and Implications
Sensitivity analyses restricted to patients aged 60 years or older yielded comparable findings. Additional comparisons with individual selective glucagon-like peptide-1 receptor agonists, including semaglutide and dulaglutide, showed consistent trends, supporting the robustness of the association. While glucagon-like peptide-1 receptor agonists have been proposed to offer neuroprotective effects, these data suggest that dual incretin therapy may confer additional ocular benefits. The findings highlight the need for further research to clarify underlying mechanisms and to explore the potential role of tirzepatide in glaucoma prevention and management among patients with type 2 diabetes mellitus.
Reference
Hong AT et al. Tirzepatide is associated with reduced risk of primary open-angle glaucoma and ocular hypertension in patients with type 2 diabetes. Am J Ophthalmol. 2025 Dec 6:283:120-128.
