GLP-1 receptor agonists like semaglutide demonstrate reduced risk of age-related glaucoma but carry unconfirmed reports of severe nonarteritic anterior ischemic optic neuropathy. This comprehensive review examined multiple geroprotective agents including metformin, SGLT-2 inhibitors, statins, and emerging compounds like spermidine and NAD precursors for their ocular effects across major age-related eye diseases. The convergence of neurodegeneration and microvascular injury underlies conditions like macular degeneration, diabetic retinopathy, and glaucoma, making longevity-promoting drugs theoretically attractive for eye health. However, the clinical reality proves more complex. This analysis highlights a critical gap in ophthalmology: millions of patients are taking these increasingly popular medications for diabetes and weight management, yet their ocular safety profiles remain poorly characterized. The contradictory findings with GLP-1 agonists exemplify broader challenges facing clinicians who must weigh evolving pharmacologic evidence against patient safety. As these drugs gain mainstream adoption beyond their original indications, establishing clear ocular risk-benefit profiles becomes essential for preventing unintended consequences in an aging population already vulnerable to sight-threatening diseases.