Statins, widely prescribed to manage cholesterol levels and reduce cardiovascular risk, could also offer protective benefits against glaucoma, according to a large retrospective cohort study published in the British Journal of Ophthalmology.
The study, conducted by researchers at the University of California San Diego School of Medicine, found that statin use was associated with a 15%lower risk of developing open-angle glaucoma (OAG) over five years, alongside significantly reduced rates of glaucoma surgery, laser treatment, and ocular hypotensive prescriptions among patients with existing disease.
Although lowering intraocular pressure (IOP) remains the principal strategy for managing glaucoma, some patients continue to experience progressive optic nerve damage despite adequate pressure control. This has prompted growing interest in neuroprotective therapies that could complement conventional IOP-lowering treatments.
Statins have attracted particular attention because of their potential anti-inflammatory, vascular, and neuroprotective properties. However, previous studies investigating their relationship with glaucoma have produced inconsistent findings.
Examining long-term glaucoma risk
Using electronic health records from the TriNetX research network, which encompasses 115 healthcare organizations, the researchers examined associations between statin use and glaucoma incidence and treatment escalation over five- and 10-year periods.
The incidence analysis included 210,701 statin users aged over 40, matched with an equal number of non-users. A separate analysis of patients with pre-existing OAG included 29,598 individuals in each cohort.
At five years, 2.3% of statin users had developed OAG, compared with 2.6% of non-users, corresponding to a hazard ratio (HR) of 0.85. The association also persisted at 10 years, although the relative reduction was smaller (HR, 0.90).
Among patients with established glaucoma, statin use was also associated with considerably lower rates of treatment escalation.
At five years, statin users demonstrated a 36% lower risk of incisional glaucoma surgery, a 55% lower risk of minimally invasive glaucoma surgery (MIGS), and a 60% lower risk of selective laser trabeculoplasty (SLT). The likelihood of receiving a topical ocular hypotensive prescription was also 11 percent lower. These associations remained statistically significant at 10 years, with corresponding risk reductions of 32%, 46 percent, 51% and 12%, respectively.
Subgroup analyses suggested that atorvastatin and rosuvastatin were consistently associated with reduced glaucoma incidence and treatment escalation. Results for simvastatin and pravastatin were less consistent, potentially reflecting smaller cohort sizes.
A potential neuroprotective role?
The researchers highlighted several mechanisms that could explain the observed associations, including statins' ability to modulate inflammatory pathways, improve retinal blood flow, and reduce oxidative damage. Experimental evidence also suggests that atorvastatin may increase aqueous humor outflow through effects on the Rho/ROCK signaling pathway that relax cells in the trabecular meshwork.
However, the authors acknowledged several important limitations. The database lacked detailed measurements of IOP, visual fields and optic nerve imaging, preventing direct assessment of glaucoma progression. Treatment escalation was therefore used as an indirect indicator of disease severity, while the observational design precluded conclusions about causality.
Still, the findings strengthen the case for investigating statins as potential adjunctive therapies for glaucoma. The researchers conclude that prospective randomized trials are now needed to establish whether statins can genuinely reduce disease onset or progression beyond their established cardiovascular benefits.
