Impact of SGLT2 inhibitors on the risk of age‐related ocular diseases in patients with type 2 diabetes mellitus: A target trial emulation study

Aims Chronic ocular diseases such as age‐related macular degeneration (AMD) are leading causes of vision loss in older adults. While sodium‐glucose co‐transporter 2 inhibitors (SGLT2i) are widely prescribed in the management of type 2 diabetes mellitus (T2DM), their effects on ocular disease risk remain largely unknown. Materials and Methods This retrospective cohort study evaluated the association between SGLT2i use and the risk of AMD and other age‐related ocular conditions in adults aged ≥60 with T2DM, using a target trial emulation framework based on the TriNetX global health research network (2013–2025). Patients initiating SGLT2i or dipeptidyl peptidase‐4 inhibitors (DPP4i) were propensity‐matched 1:1. Primary outcomes were incident non‐exudative, exudative, and atrophic AMD, and secondary outcomes included cataract, ocular hypertension, and primary open‐angle glaucoma. Results In 12 156 matched patients, SGLT2i use was associated with significantly lower risks of non‐exudative AMD (HR 0.64; 95% CI 0.49–0.84) and exudative AMD (HR 0.56; 95% CI 0.33–0.96) compared with DPP4i use. A slight increase in the risk of cataract was observed (HR 1.08; 95% CI 1.02–1.15), while no significant differences were found for atrophic AMD, ocular hypertension, or glaucoma. Conclusions These findings suggest that SGLT2i may offer retinal protective effects in older adults with T2DM, supporting further mechanistic and prospective clinical studies.