In previous studies, DPP4i have demonstrated potential neuroprotective effects independent of glycemic control, which may have contributed to the reduced risk of glaucoma observed in this study. This chart from the study shows a significantly lower cumulative incidence of POAG in DPP4i vs. non-DPP4i users.
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In a recent study, researchers investigated the association between DPP4i and the risk of primary open-angle glaucoma and normal-tension glaucoma in diabetes patients; they found patients on this drug had a significantly lower risk compared to users of first-generation diabetes medication, such as metformin, among others. 

“These antioxidative properties, combined with their ability to remodel ocular connective tissue, may explain the associations observed in our study,” the authors wrote in their paper. “This suggests that DPP4i may mitigate some of the oxidative toxicity as well as structural changes associated with glaucoma progression.”

Overall, these findings suggest that DPP4i drugs may offer benefits beyond glycemic control, possibly influencing optic nerve health through multiple mechanisms. Further research is needed to explore the underlying mechanisms and their implications for glaucoma prevention and management, the authors concluded.

Lu Y-A, Tien P-T, Cheng Y-D, et al. Association of dipeptidyl peptidase-4 inhibitors with glaucoma risk in patients with type 2 diabetes: a nationwide cohort study. Ophthalmol Sci. May 8, 2025.