Patients diagnosed with glaucoma have an increased risk of developing neurodegenerative conditions, including Alzheimer disease and vascular dementia.
Patients with glaucoma face a significant risk of developing subsequent neurodegenerative and cognitive disorders, according to a 10-year retrospective cohort study published in the American Journal of Ophthalmology
The study was conducted in Taiwan. The researchers analyzed real-world electronic health records collected from the United States-based TriNetX database, encompassing 384,256 propensity-score-matched pairs tracked over a decade.
Associations between glaucoma and neurodegenerative disorders were strongest with Alzheimer disease (AD; relative risk [RR]=1.558, P <.0001) and vascular dementia (VD). The researchers report that absolute hazard ratios varied by clinical subtype and age of onset, but all 3 glaucoma subtypes they looked at — primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG), and normal-tension glaucoma (NTG) — maintained significant associations with unspecified dementia
Temporal trend analyses indicated that the risks of AD and VD emerged early following a glaucoma diagnosis and persisted throughout the follow-up period. The researchers note that Parkinson disease (PD) risk became statistically significant only after 5 years of follow-up. In addition, subgroup analyses revealed highly divergent, phenotype-specific risk pathways.
These risks manifested as early as within 1 year after glaucoma diagnosis and persisted throughout the 10-year follow-up
Although no clinical subtype showed a significant independent association with AD, unique pairings emerged for other conditions, according to the researchers. PACG, for example, was predominantly associated with VD, whereas mild cognitive impairment (MCI) risk increased only in the POAG and NTG cohorts.
“Our current findings show that AD and VD risks were the most pronounced, with HRs of 1.485 and 1.213, respectively. These risks manifested as early as within 1 year after glaucoma diagnosis and persisted throughout the 10-year follow-up. A 10-year study from Korea revealed an elevated risk of AD but not PD among patients with OAG; similarly, in our patient population, glaucoma was only weakly associated with PD…and MCI,” according to the researchers. “Potential explanation for these associational differences may reflect the involvement of different brain regions in PD versus AD and VD, which involve regions that are connected with visual input (hippocampus and posterior cortex), whereas PD involves dopaminergic degeneration in the basal ganglia.”
Study limitations include reliance on ICD-10 administrative billing codes, which are susceptible to diagnostic delays and systemic undercoding. In addition, patients with glaucoma undergo rigorous, lifelong clinical surveillance; as a result, the cohort may be subject to surveillance and other biases that increase the likelihood of early dementia detection
The investigators stress that the correlations uncovered by their study do not confirm direct causal or mechanistic linkages. As a result, they recommend prospective studies incorporating granular clinical phenotyping, functional visual field data, and structural imaging metrics to validate the longitudinal progression patterns
Wong MS, Wang J, Lin YH, Wu CW, Chen HY, Lu KC.Glaucoma and neurodegenerative disease risk: a 10-year assessment of real-world global data.Am J Ophthalmol. Published online August 3, 2026. doi:10.1016/j.ajo.2026.07.051
