Objective:

To investigate the relationship between long-term statin use and the risk of ocular hypertension and primary open-angle glaucoma (POAG).

Approach:

• Study Design: A nationwide analysis from Taiwan using a nested case–control design within the Taiwan National Health Insurance Research Database (2009–2020).
• Patient Population: Included over 160,000 patients with hyperlipidemia and more than 63,000 glaucoma cases.
• Matching Criteria: Patients newly diagnosed with ocular hypertension, POAG, or normal-tension glaucoma (NTG) were matched with hyperlipidemic controls based on demographics, comorbidities, and prior cholesterol-medication use.

Key Findings:

• Statin users showed a statistically significant increase in risk for both ocular hypertension and POAG (aOR 1.19 for ocular hypertension; 1.09 for POAG with atorvastatin; aOR 1.11 for ocular hypertension; 1.07 for POAG with rosuvastatin).
• The association between statin use and glaucoma risk strengthened with duration of use.
• In hyperlipidemic patients using statins for more than three years, the risk of POAG roughly doubled.
• Atorvastatin and rosuvastatin were associated with increased risks for ocular hypertension and POAG.
• Pitavastatin was associated with a lower POAG risk in short-term users, but longer use showed a trend toward increased risk.
• No statin was associated with NTG risk in the primary analysis, though prolonged use suggested a possible increase.
• Fibrates showed small but significant increases in ocular hypertension and POAG risk.

Interpretation:

Limitations:

• Effect sizes are small.
• Confounding from cardiovascular and metabolic factors cannot be fully excluded.
• The authors call for randomized controlled trials to determine whether statins directly contribute to glaucomatous damage.

Conclusion:

Sources:

• Investigative Ophthalmology & Visual Science