Glucagon-like peptide-1 receptor agonists and the eye

Mar 27, 2025Current opinion in ophthalmology

Effects of Glucagon-like Peptide-1 Receptor Activators on the Eye

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Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RA) may be linked to an increased risk of nonarteritic ischemic optic neuropathy (NAION).

The relationship between GLP-1RA and diabetic retinopathy (DR) is controversial, potentially due to rapid changes in hemoglobin A1c levels.
GLP-1RA may increase the risk of NAION, although the underlying mechanism is not yet understood.
Protective effects of GLP-1RA against glaucoma, age-related macular degeneration (AMD), and dry eye disease (DED) may be related to anti-inflammatory properties.
These medications could help lower intracranial pressure in cases of idiopathic intracranial hypertension (IIH).
Further ocular safety trials are needed to clarify the risk of eye-related complications associated with GLP-1RA.

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PURPOSE OF REVIEW: Glucagon-like peptide-1 receptor agonists (GLP-1RA) have gained popularity as an antidiabetic and weight loss agent with protective cardiovascular outcomes, but attention to the potential ocular side effects has grown. This review aims to consolidate the existing evidence on the effects of GLP-1RA on conditions such as diabetic retinopathy (DR), nonarteritic ischemic optic neuropathy (NAION), glaucoma, age-related macular degeneration (AMD), idiopathic intracranial hypertension (IIH), and dry eye disease (DED).

RECENT FINDINGS: The effect of GLP-1RA on DR is controversial but likely linked to rapid correction of hemoglobin A1c levels. GLP-1RA may be associated with increased risk of NAION, although the mechanism remains elusive. Protective effects have been shown against glaucoma, AMD, and DED possibly due to its anti-inflammatory properties, and these medications may decrease intracranial pressure in IIH.

SUMMARY: As the usage of GLP-1RA increases, further dedicated ocular safety trials are key to determining the risk of eye-related complications. Given the limited prospective evidence available and the proven systemic benefits of the medication, as well as its potential protective effects on certain eye diseases, GLP-1RA use should generally not be discouraged in most patients. Regular ophthalmologic follow up is important in patients considered at higher risk of ocular adverse events.

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Glucagon-like peptide-1 receptor agonists and the eye

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