Glucagon-Like Peptide-1 Analogs Associated with a Reduced Risk of Legal Blindness in Type 2 Diabetics with Cardiovascular Risks

Mar 30, 2026Clinical ophthalmology (Auckland, N.Z.)

Glucagon-Like Peptide-1 Drugs Linked to Lower Risk of Legal Blindness in Type 2 Diabetics with Heart Disease Risks

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Abstract

GLP-1 receptor agonist therapy was associated with a significantly reduced risk of over 5 years.

The study involved 350,536 adults with type 2 diabetes and cardiovascular risk factors.
A reduced risk of legal blindness was observed at 1 year (HR 0.589), 3 years (HR 0.677), and 5 years (HR 0.669).
No significant differences in the incidence of were found at any follow-up period.
Findings suggest that GLP-1 receptor agonists may provide ocular benefits in addition to their effects on blood sugar and heart health.

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PURPOSE: To evaluate whether glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy influences the risk of and (ION) among patients with type 2 diabetes mellitus (T2DM) and cardiovascular risk factors (CVRF).

DESIGN: A retrospective cohort study using de-identified electronic medical record (EMR) data from TriNetX, encompassing 72 healthcare organizations across the United States between January 2018 and January 2025.

PARTICIPANTS: Adults (≥18 years) with T2DM (A1c <10%) and at least one CVRF (hyperlipidemia, essential hypertension, overweight/obesity, or chronic ischemic heart disease) who were prescribed or not prescribed a GLP-1 RA.

METHODS: Patients with type 1 diabetes, optic neuritis, giant cell arteritis, or phosphodiesterase-5 inhibitor use were excluded. GLP-1 RA users were required to have ≥2 prescription records. A 1:1 propensity score matching (PSM) was performed to balance demographics, comorbidities, laboratory values, and concurrent antidiabetic medications. Outcomes were assessed at 1-, 3-, and 5-year follow-ups. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using univariable survival analyses.

MAIN OUTCOME MEASURES: Incidence of legal blindness and ischemic optic neuropathy.

RESULTS: After PSM, each cohort included 350,536 patients (mean age 58.7 ± 12.6 years; 61.6% female). GLP-1 RA use was associated with a significantly reduced risk of legal blindness at 1 year (HR 0.589, 95% CI 0.476-0.728), 3 years (HR 0.677, 95% CI 0.583-0.788), and 5 years (HR 0.669, 95% CI 0.583-0.768). There was no significant difference in ION incidence between cohorts at 1 year (HR 0.872, 95% CI 0.627-1.212), 3 years (HR 1.002, 95% CI 0.792-1.268), or 5 years (HR 0.978, 95% CI 0.789-1.211).

CONCLUSION: GLP-1 receptor agonist therapy was associated with a significantly lower risk of legal blindness and no difference in ION incidence. These findings indicate potential ocular benefits of GLP-1 RAs beyond glycemic and cardiovascular outcomes.

Key numbers

0.589

Decrease in Risk (1-Year)

Hazard Ratio for at 1-year follow-up

0.677

Decrease in Risk (3-Year)

Hazard Ratio for at 3-year follow-up

0.669

Decrease in Risk (5-Year)

Hazard Ratio for at 5-year follow-up

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Glucagon-Like Peptide-1 Analogs Associated with a Reduced Risk of Legal Blindness in Type 2 Diabetics with Cardiovascular Risks

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