Background: Glaucoma is a leading cause of irreversible blindness with limited known modifiable risk factors. Studies have shown that obesity-induced inflammation and oxidative stress may inflict optic nerve damage. Currently, there is limited understanding of whether managing obesity with weight loss medications could potentially be preventative for glaucoma.

Objective: This study aims to assess the association between obesity medications and glaucoma prevalence in the National Institutes of Health(NIH) All of Us (AoU) Research Database

Methods: Participants with a body mass index (BMI) of 27 or higher were identified in NIH AoU from 2019-2022. Those who were pregnant or had a diagnosis of glaucoma prior to or on the day of filling their first obesity medication prescription were excluded. The primary exposures were the use of glucagon-like-peptide 1(GLP-1) agonists, sympathomimetics, and bupropion. Glaucoma was defined by International Classification of Diseases, Ninth and Tenth Revision codes. Multivariable logistic regression was used to examine the association between any use of each medication and glaucoma, adjusting for diabetes, age, sex, race, income, and education level.

Results: Among 136,055 participants with elevated BMI, 2719(2.0%) had glaucoma. Bupropion, GLP-1 agonists, and sympathomimetics, were used by 11145(8.2%), 4050(3.0%), 2584(1.9%), respectively. GLP-1 agonists were associated with reduced adjusted odds of glaucoma (adjusted odds ratio [aOR]: 0.54, 95% confidence interval[CI]: 0.42-0.68) . Sympathomimetics were associated with decreased unadjusted odds of glaucoma (unadjusted OR: 0.52, 95% CI: 0.35-0.75) but the results were not statistically significant in the adjusted analysis (aOR: 0.82, 95% CI: 0.56-1.20). Bupropion (aOR: 1.13, 95% CI: 0.98-1.39) was associated with increased odds of glaucoma, but it was not statistically significant.

Conclusions:  Among AoU participants with elevated BMI, GLP agonists were associated with decreased likelihood of glaucoma. Further studies investigating potential neuroprotective mechanisms of obesity medications in individuals with glaucoma would be of benefit.