GLP-1 Agonists Tied to Slightly Increased Risk of New-Onset Diabetic Retinopathy: JAMA
USA: A large retrospective cohort study has revealed that the use of GLP-1 receptor agonists was associated with a 7% higher risk of developing new-onset diabetic retinopathy, although it did not increase the progression to proliferative retinopathy or diabetic macular edema. Regular eye screening is recommended for all patients taking these medications.
The research, published in JAMA Network Open by David J. Ramsey, MD, PhD, MPH, from the Department of Ophthalmology, Tufts University School of Medicine, Boston, and colleagues, examined whether glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with sight-threatening eye complications in patients with type 2 diabetes (T2D). While GLP-1 RAs are increasingly used for glycemic control and weight loss, concerns remain regarding their ocular safety profile.
Using data from the TriNetX database, the investigators analysed records from 185,066 adults with T2D and a hemoglobin A1c of at least 6.5%. Participants were matched through propensity score methods based on whether they had received at least two GLP-1 RA prescriptions, spaced six months apart. The follow-up period spanned two years, with outcomes assessed using Cox proportional hazard models.
Key Findings
- GLP-1 RA use was linked to a modest but statistically significant increase in the incidence of diabetic retinopathy (HR, 1.07).
- There was no significant increase in cases of nonarteritic anterior ischemic optic neuropathy (HR, 1.26).
- In patients with preexisting diabetic retinopathy, GLP-1 RAs did not associate with progression to proliferative diabetic retinopathy (HR, 1.06) or diabetic macular edema (HR, 0.98).
- Treatment was associated with reduced rates of vitreous hemorrhage (HR, 0.74), neovascular glaucoma (HR, 0.78), and new-onset blindness (HR, 0.77).
The findings suggest that while GLP-1 RAs may slightly raise the risk of developing diabetic retinopathy, they do not accelerate its advancement to more severe stages and may even reduce the occurrence of serious vision-threatening complications.
The authors noted several limitations, including reliance on electronic health records, which may vary in coding practices and completeness, and the absence of consistent HbA1c measurements to assess the role of rapid glucose lowering. Additionally, the study could not account for all social determinants of health or differences in access to ophthalmic care, which might influence detection and treatment rates. The lack of eye examination data, reliance on administrative coding for blindness, and the inability to distinguish among specific GLP-1 agents also constrain the interpretation.
Despite these limitations, the researchers emphasize the importance of regular ophthalmologic monitoring for all T2D patients prescribed GLP-1 RAs, regardless of their baseline retinal status. Further studies are needed to clarify whether the protective association with certain complications translates into long-term reductions in vision loss.
Reference:
Ramsey DJ, Makwana B, Dani SS, et al. GLP-1 Receptor Agonists and Sight-Threatening Ophthalmic Complications in Patients With Type 2 Diabetes. JAMA Netw Open. 2025;8(8):e2526321. doi:10.1001/jamanetworkopen.2025.26321
