On August 19, 2026, Gizmodo reported on a study published that month in the British Journal of Ophthalmology linking long-term tadalafil use to an elevated risk of glaucoma — a finding that rippled through consumer health media for the following two weeks and reached mainstream men's outlets by August 31. Researchers in Taiwan drew on an anonymized real-world patient database, comparing 36,927 men over 40 taking tadalafil for lower urinary tract symptoms against 36,927 age-matched men not on PDE5 inhibitors, and tracked both groups over five years.

Why It Matters

Tadalafil is now one of the most widely dispensed drugs in the men's health economy, and the telehealth platforms built on it — Hims, Ro, BlueChew and a long tail of copycats — have spent five years normalizing daily-dose subscription models specifically because recurring pills beat one-off scripts on lifetime value. That business model is precisely the exposure profile this study examined. A daily-dose safety signal is a materially different commercial risk than an as-needed one. Nobody in the sector should overreact to a retrospective database study with a sub-1% absolute risk difference and no proven causal mechanism. But the ED telehealth category is already under regulatory pressure over data privacy and subscription billing, and it operates in an advertising environment where "FDA-approved generic, delivered discreetly" does a lot of heavy lifting. If ophthalmic screening guidance eventually attaches to chronic PDE5 use, the friction lands squarely on the asynchronous, no-office-visit model that makes these platforms cheap to run. Expect the smarter operators to get ahead of it with intake-form screening questions about family history of glaucoma — a low-cost hedge that also happens to look good in a future enforcement action.

The headline number: tadalafil use was associated with a roughly 22% higher relative risk of developing glaucoma over the five-year window, along with elevated rates of ocular hypertension and open-angle glaucoma, and a greater likelihood of starting glaucoma treatment. The authors' recommendation was measured — "Ophthalmic evaluation and follow-up may be considered, particularly in patients with risk factors for glaucoma."

The absolute numbers are far less dramatic than the headlines. Per Gizmodo's reporting of the data, 3.93% of men over 50 taking tadalafil developed glaucoma across the five years versus 3.16% of non-users — a 0.77 percentage-point absolute difference. Crucially, the cohort studied was taking a daily low dose for an enlarged prostate, not the higher intermittent doses typical of on-demand erectile dysfunction use. Stanford urology professor Craig Comiter told Healthline that "the absolute risk was less than 1% greater with daily tadalafil," and urologist S. Adam Ramin characterized the risk as "relatively small, but it's important to discuss this with patients." Cedars-Sinai ophthalmologist Bavand Youssefzadeh told Men's Health the study "shows an association between tadalafil and glaucoma, but it does not prove that tadalafil causes glaucoma," calling it "an important signal that deserves further study, not a definitive cause-and-effect finding."

Mechanistically, the leading hypotheses are unglamorous but plausible. PDE5 inhibitors relax smooth muscle and dilate blood vessels; Ohio State clinical professor of optometry Aaron Zimmerman noted to Men's Health that in the eye this can increase intraocular fluid and pressure, and separately that impaired autoregulation of blood supply to the optic nerve in older adults could compound the effect.

Sources

Update — 2026-09-06

{Initial entry — story first created.}