Recent studies suggest that the diabetes drug metformin has  a protective effect on open-angle glaucoma (OAG) and age-related macular  degeneration (AMD). However, studies have not addressed the critical issue of  confounding by indication, and associations have not been evaluated in a large  prospective cohort.
    A study was conducted to determine the association between  diabetes medication and the common eye diseases OAG, AMD, and cataracts and to  evaluate their cumulative lifetime risks in a large cohort study.
    This cohort study included participants from 3 independent  cohorts from the prospective, population-based Rotterdam Study between April  23, 1990, and June 25, 2014. Participants were monitored for incident eye  diseases (OAG, AMD, cataract) and had baseline measurements of serum glucose.  Data on diabetes medication use and data from ophthalmologic examinations were  gathered.
    Results:
    - This study included 11 260 participants 
 - T2D was diagnosed in 2406 participants (28.4%), open-angle  glaucoma (OAG) was diagnosed in 324 of 7394 participants (4.4%), and age-related  macular degeneration (AMD) was diagnosed in 1935 of 10 993 participants  (17.6%), and cataract was diagnosed in 4203 of 11 260 participants (37.3%).
 - Untreated T2D was associated with a higher risk  of open-angle glaucoma (OAG), and cataract.
 - T2D treated with metformin was associated with a  lower risk of open-angle glaucoma (OAG). 
 - Other diabetes medication (ie, insulin,  sulfonylurea derivates) was associated with a lower risk of age-related macular  degeneration (AMD) 
 - The cumulative lifetime risk of open-angle  glaucoma (OAG) was lower for individuals taking metformin than for individuals  without T2D the lifetime risk of age-related macular degeneration (AMD) was  lower for individuals taking other diabetes medication 
 
                        Thus, results of this cohort study suggest that, although  diabetes was clearly associated with cataract, diabetes medication was not.  Treatment with metformin was associated with a lower risk of OAG, and another  diabetes medication was associated with a lower risk of AMD. Proof of benefit  would require interventional clinical trials.
    Reference:
    Association of Diabetes Medication with Open-Angle Glaucoma,  Age-Related Macular Degeneration, and Cataract in the Rotterdam Study, "by  Joëlle E. Vergroesen et al. published in JAMA Ophthalmology
    doi:10.1001/jamaophthalmol.2022.1435
    Keywords:
    Metformin, associated, lower, risk, OAG, treatment,  diabetes, medication, lower risk, AMD, JAMA Ophthalmology, Cataract, Lens  Disorders, Open-Angle Glaucoma, Age-Related Macular Degeneration, and Cataract,  Joëlle E. Vergroesen, Eric F. Thee, Fariba Ahmadizar, Cornelia M. van Duijn,  Bruno H. Stricker, Maryam Kavousi, Caroline C. W. Klaver, MD, Wishal D. Ramdas,  Metformin
     
 
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