Risk of Glaucoma in Men Taking Sildenafil: A Propensity-Score-Matched Study

Purpose: To explore the association between sildenafil use and the risk of developing glaucoma among men with erectile dysfunction. Patients and Methods: This study was conducted using the TriNetX Network, a federated database containing de-identified health records from over 130 million patients globally. Men aged 18 years and over diagnosed with erectile dysfunction between 2000 and 2019 were identified. Included patients were separated into study and control cohorts based on sildenafil prescription status. Cohorts were 1:1 propensity score-matched by age, race/ethnicity, comorbidities, and lifestyle factors. All patients were monitored for a minimum of 5 years for glaucoma development, with risk assessed using hazard ratios and 95% confidence intervals. Results: After matching, each cohort contained 182,335 patients with erectile dysfunction. Men with a sildenafil prescription demonstrated an elevated risk of developing glaucoma compared to matched controls at 1 year (HR: 1.38 [CI: 1.29–1.47]), 3 years (HR: 1.23 [CI: 1.18–1.29]), and 5 years (HR: 1.18 [CI: 1.14–1.22]) post index date. Significantly elevated risk was observed for the development of primary open-angle glaucoma (HR: 1.25 [CI: 1.18–1.33]) and low-tension glaucoma (HR: 1.87 [CI: 1.54–2.26]). Risk of developing preglaucoma (HR: 1.29 [CI: 1.23–1.36]) and ocular hypertension (HR: 1.21 [CI: 1.13–1.29]) was also elevated among sildenafil users. Conclusion: In a large, real-world analysis of men with erectile dysfunction, patients with a sildenafil prescription demonstrated an increased risk of developing glaucoma compared to matched controls.