Association between probiotic prescriptions and the incidence of primary open-angle glaucoma in patients with documented dry eye.

PURPOSE: To examine the association between probiotic prescriptions and the risk of developing primary open-angle glaucoma (POAG).

METHODS

A retrospective cohort study was conducted using the TriNetX multinational database. Adults aged ≥ 40 years with a diagnosis of dry eye and no prior history of glaucoma were included. Participants were categorized into probiotic and non-probiotic groups based on prescription records. Propensity score matching (1:1) was performed to balance demographics, comorbidities, and medication use. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs), and Kaplan-Meier analyses assessed five-year cumulative incidence. Sensitivity and subgroup analyses were performed to examine robustness and consistency across clinical subgroups.

RESULTS

Among 15,613 matched pairs, probiotic prescriptions were associated with lower risks of POAG (HR: 0.44; 95% CI: 0.32-0.61). These associations remained consistent in sensitivity analyses and were observed across multiple subgroups stratified by age, sex, race, diabetes status, and obesity.

CONCLUSIONS

Probiotic prescriptions were associated with a reduced risk of POAG in this large real-world cohort. These findings highlight the need for prospective studies to confirm causality and explore underlying mechanisms.