I’m 71. Like a lot of men my age, I’ve had the conversation about the prostate — the one where the doctor asks how many times you get up at night and you fudge the number downward.
A common answer to that problem is a daily pill called tadalafil. You know it as Cialis. It’s FDA-approved for erectile dysfunction and for benign prostatic hyperplasia, the medical name for an enlarged prostate. A lot of men take it every day.
Now a large new study says those men should be paying closer attention to their eyes.
What the study found
The research was recently published in the British Journal of Ophthalmology. Researchers pulled records on 73,854 men aged 40 and up from a large health database covering 2012 through 2022, and followed them for up to five years.
Half the men had been prescribed tadalafil. The other half hadn’t taken any drug in that class. The two groups were matched on age, ethnicity, smoking, alcohol problems, other medications and a long list of health conditions — heart disease, diabetes, cancer, cholesterol, kidney function, obesity, lung disease.
Here’s what came out, according to the journal’s release. Compared with the men who weren’t on the drug, the tadalafil group was:
- 22% more likely to be diagnosed with glaucoma.
- 32% more likely to have ocular hypertension — high pressure inside the eye.
- 33% more likely to develop primary open-angle glaucoma, the most common form.
- 33% more likely to start glaucoma treatment.
Those gaps showed up early, too. The pattern held for men diagnosed within one, three and six months of starting the drug.
Now the part the headlines skip
A 22% higher risk sounds alarming. Let me put it in real numbers, because the abstract gives them.
Over five years, 3.93% of the tadalafil users developed glaucoma. Among the men not taking it, the figure was 3.16%.
That’s a difference of less than one percentage point — roughly eight extra cases for every 1,000 men over five years. It’s real. It’s also modest. Anyone telling you Cialis is going to blind you is selling something, the same way the scary Ozempic-and-blindness headlines skipped the numbers.
The authors are careful about this. It’s an observational study, meaning it can show a link but can’t prove the drug caused the glaucoma. They couldn’t confirm whether men actually took the pills they were prescribed.
And most of the participants were white, so the results may not translate to every man.
Their bottom line: Don’t quit the drug. Get your eyes checked, especially if you already have glaucoma or it runs in your family.
Why glaucoma is the disease you don’t feel
Here’s what makes this worth your time, even at modest odds.
Glaucoma damages the optic nerve, the cable that carries what your eye sees to your brain. According to the National Eye Institute, it typically has no early symptoms. None. Your vision narrows from the edges so slowly you don’t notice, and by the time you do, that vision is gone.
Treatment — usually prescription drops, sometimes laser or surgery — can stop the damage from getting worse. It can’t give back what you’ve already lost. There’s no cure.
That’s why the NEI says roughly half the people who have glaucoma don’t know it. The only way to find it early is to have someone look.
Risk already climbs after 60. Add a family history, or being African American over 40 or Hispanic and over 60, and it climbs more. Add a daily pill that may nudge it higher still, plus the everyday habits that wear on your eyes, and you’ve got every reason to schedule the exam.
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What the exam actually involves
If you’ve been putting this off because you picture something unpleasant, relax. The whole thing takes less time than a haircut.
The NEI describes it as a comprehensive dilated eye exam. The doctor puts in drops to widen your pupils, then looks at the back of your eye to check the optic nerve directly.
Expect a few hours of blurry vision and light sensitivity afterward, so bring sunglasses and maybe a driver.
You’ll also get a pressure check — the puff of air or the gentle probe that touches the eye.
And you’ll get a visual field test, where you stare at a point and click a button when lights flash at the edges. That’s the test that catches peripheral loss you’d never notice on your own.
No pain. No needles. Just a morning.
What Medicare pays for
If you’re on Medicare, Part B covers a glaucoma screening once every 12 months if you’re considered high risk. Medicare’s list of who qualifies: you have diabetes, you have a family history of glaucoma, you’re African American and 50 or older, or you’re Hispanic and 65 or older.
Notice what’s not on that list: taking tadalafil, or having an enlarged prostate. This study is brand new, and Medicare’s rules won’t change overnight.
As for cost, here’s Medicare’s language: After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. In a hospital outpatient setting, you also pay a copayment.
If you don’t fit a high-risk category, a Medicare Advantage plan may cover routine eye exams anyway — check yours. And if you end up paying out of pocket, call around and ask the price up front. Against permanent vision loss, it’s a bargain.
The questions to bring to your doctor
Print this, or pull it up on your phone. Ask the doctor who prescribes your tadalafil:
- Have I ever had a baseline eye exam since I started this drug? If not, will you write the referral?
- Do I have any glaucoma risk factors you already know about — family history, diabetes, high eye pressure from a past exam?
- How often should I be rechecked while I stay on the medication?
- Are there other options for my prostate symptoms if my eye doctor finds a problem?
And ask the eye doctor one thing: “I take tadalafil daily. Does that change what you want to watch?”
I’ll say it once more, because the study’s authors did: Don’t stop taking the drug on your own. Stopping a medication that’s working over a modest, unproven risk is a bad trade. Getting your eyes checked once a year costs you a morning. That’s an easy one.
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