For decades, health advice has drawn a clear line between “good” (HDL) and “bad” (LDL) cholesterol, but a surprising new study published in the British Journal of Ophthalmology suggests this traditional view might not hold when it comes to eye health, especially for those over the age of 55. The research, based on long-term data from the UK Biobank Study, presents a paradox: high levels of HDL may increase the risk of developing glaucoma, while LDL and other blood fats may actually lower it. This finding could have important implications for people living with or at risk for glaucoma.

The Link Between Cholesterol and Glaucoma

Glaucoma, a disease characterized by damage to the optic nerve, affects millions globally and is expected to impact 112 million people by 2040. The condition is typically linked to factors such as age, eye pressure, family history, and ethnicity. Previous studies have hinted at possible connections between blood lipids and eye diseases like macular degeneration and diabetic retinopathy, but findings have been inconsistent regarding glaucoma.

In this new study, researchers tracked the health of over 400,000 participants aged 40 to 69 for nearly 14 years. Of these, about 6,868 individuals (just under 2%) developed glaucoma. The data revealed that those who developed the disease tended to:

• Be older, 
• Have higher waist-to-hip ratios, and 
• Have other health issues, such as diabetes or cardiovascular disease. 

They also had higher HDL but lower LDL cholesterol levels compared to those who didn’t develop glaucoma.

Unexpected Findings on Good v. Bad Cholesterol

One of the most eye-opening findings was that higher HDL cholesterol levels—traditionally seen as protective—were associated with a 10% increased risk of developing glaucoma. In contrast:

• Higher LDL cholesterol, 
• Total cholesterol, and 
• Triglycerides correlated with a lower risk of glaucoma.

Participants with the highest LDL levels had an 8% lower risk of glaucoma, and those with the highest triglyceride levels saw a 14% reduction. These results challenge the long-held belief that HDL is universally beneficial and LDL universally harmful. Importantly, these associations were not found in participants under 55, indicating a possible age-related mechanism at play.

What This Means for People Living with Glaucoma

Though this is an observational study and doesn’t prove cause and effect, the findings suggest it may be time to revisit how lipid levels are managed in patients at risk for developing or worsening glaucoma. The results also highlight the complexity of cholesterol’s role in different parts of the body, including the eyes. More research is needed to understand the biological mechanisms behind these associations.

For people living with glaucoma, these findings offer a reason to discuss lipid management with their healthcare provider, especially if they’re over 55 and already managing other cardiovascular risks. Personalized treatment strategies that take eye health into account might eventually become part of routine care, helping to refine prevention and intervention approaches for this sight-threatening condition.

*BMJ Group. (2025, February 4). High HDL cholesterol may increase glaucoma risk in older adults. News-Medical. https://www.news-medical.net/news/20250204/High-HDL-cholesterol-may-increase-glaucoma-risk-in-older-adults.aspx#:~ 

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