Objective:

To assess associations between statin use and open-angle glaucoma (OAG) incidence and treatment escalation.

Approach:

• Study design: Retrospective cohort study using electronic health records from the TriNetX network, covering 115 healthcare organizations.
• Cohorts: For incidence analyses, 210,701 statin users aged over 40 were matched with 210,701 non-users. For treatment outcomes, 29,598 patients with existing OAG were included in each group.
• Follow-up: Associations were assessed over five and 10 years.

Key Findings:

• At five years, OAG occurred in 2.3% of statin users and 2.6% of non-users (hazard ratio 0.85); the association persisted at 10 years (hazard ratio 0.90).
• Among patients with OAG, statin use was associated at five years with lower rates of incisional surgery (36%), minimally invasive glaucoma surgery (55%), selective laser trabeculoplasty (60%), and topical ocular hypotensive prescriptions (11%).
• The treatment associations remained statistically significant at 10 years, with corresponding risk reductions of 32%, 46%, 51%, and 12%.
• Atorvastatin and rosuvastatin were consistently associated with reduced incidence and treatment escalation; findings for simvastatin and pravastatin were less consistent.

Interpretation:

The authors report associations between statin use and lower OAG incidence and treatment escalation, but the observational study cannot establish causality.

Limitations:

• The database lacked detailed intraocular pressure, visual-field, and optic-nerve imaging measurements, limiting direct assessment of glaucoma progression.
• Treatment escalation was used as an indirect indicator of disease severity.
• The observational design precludes conclusions about whether statins caused the observed differences.

Conclusion:

The researchers state that prospective randomized trials are needed to determine whether statins reduce glaucoma onset or progression.

Sources:

• Article context