Published in Investigative Ophthalmology & Visual Science, the study is one of the largest and methodologically strict to date, using a nested case–control design within the Taiwan National Health Insurance Research Database (2009–2020). Patients newly diagnosed with ocular hypertension, POAG, or normal-tension glaucoma (NTG) were matched with hyperlipidemic controls on demographics, comorbidities, and prior cholesterol-medication use.
Across all models, statin users showed a statistically significant increase in risk for both ocular hypertension and POAG. Notably, the association strengthened with duration. In hyperlipidemic patients using statins more than three years, POAG risk roughly doubled for multiple agents, including atorvastatin and rosuvastatin.
Drug-specific analysis revealed meaningful differences between the statins used and the risks involved:
Atorvastatin: aOR 1.19 for ocular hypertension; 1.09 for POAG
Rosuvastatin: aOR 1.11 for ocular hypertension; 1.07 for POAG
Fluvastatin and pravastatin also showed elevated POAG risk
Pitavastatin was the only agent associated with a lower POAG risk in short-term users, though longer use showed a trend toward increased risk similar to other statins
Importantly, no statin was associated with NTG risk in the primary analysis, though prolonged use (over three years) suggested a possible increase that warrants further investigation.
Fibrates (cholesterol-lowering medication used to reduce the risk of heart disease) showed a similar pattern to statins — small but significant increases in ocular hypertension and POAG risk, though effect sizes were marginal.
Although the study's findings are statistically significant, the effect sizes are small, and the authors do note that, "considering the well-established cardiovascular benefits and cost-effectiveness of statins, our findings alone may not justify changes to current statin prescribing practices based on glaucoma risk."
However, given these findings ophthalmologists may wish to monitor long-term statin users more closely, especially those on high-intensity agents, as well as considering statin exposure duration when they are assessing patients for glaucoma risk.
This new analysis strengthens the evidence that statin use is not protective for glaucoma and may indeed slightly elevate risk, particularly with prolonged, high-intensity exposure. But causality remains uncertain, and confounding from cardiovascular and metabolic factors cannot be fully excluded. As such, the authors now call for randomized controlled trials to determine whether statins directly contribute to glaucomatous damage.
