GLP-1 Receptor Agonists Do Not Increase Risk of Retinopathy, Glaucoma, or NAION in T2DM Patients

Concerns have emerged regarding the potential for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to cause ocular adverse events in patients with Type 2 diabetes mellitus (T2DM) and obesity. These conditions are often associated with microvascular complications, including diabetic retinopathy, and there's a need to understand if GLP-1 RAs exacerbate or mitigate risks for conditions like glaucoma or non-arteritic anterior ischemic optic neuropathy (NAION). Current standard-of-care for T2DM focuses on glycemic control, but the broader systemic effects of new pharmacotherapies on sensitive organs like the eye require careful evaluation.

This systematic review and meta-analysis aggregated data from 28 observational studies published between 2006 and 2025. The studies included individuals diagnosed with diabetes and/or obesity who were receiving GLP-1 RAs. The primary objective was to assess the effects of GLP-1 RAs on the risk of ocular adverse events, specifically NAION, glaucoma, and new-onset or progression of retinopathy. A random-effect meta-analysis approach was utilized to synthesize the findings, comparing GLP-1 RAs against other antidiabetic treatments.

The analysis, encompassing 28 observational studies (6 specifically for semaglutide and 22 for all GLP-1 RAs), revealed no significant increase in the risk of ocular disorders when GLP-1 RAs were compared to other antidiabetic treatments. For NAION, the pooled risk ratio was 1.01 (95% CI, 0.62-1.64), with substantial heterogeneity (I2, 89%). Similarly, glaucoma risk showed no elevation, with a hazard ratio of 0.84 (95% CI, 0.71-1.00) and high heterogeneity (I2, 91%). The risk of new-onset retinopathy was also not increased (HR, 0.96; 95% CI, 0.85-1.08; I2, 91%). Progression of existing retinopathy likewise showed no significant difference (HR, 0.97; 95% CI, 0.83-1.14; I2, 65%).