Addressing the risk of ocular complications of GLP ‐ 1RAs ; a multi‐disciplinary expert consensus

Oct 8, 2025Diabetes, obesity & metabolism

Managing the risk of eye problems from GLP-1 receptor agonist treatments: expert agreement

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Abstract

Responses from 58 participants across 17 countries indicated that worsening diabetic retinopathy events are primarily linked to rapid blood glucose-lowering.

Worsening diabetic retinopathy is associated with rapid reductions in blood glucose levels rather than a direct effect of GLP-1 receptor agonists.
The benefits of GLP-1 receptor agonists were considered to outweigh potential ocular risks, suggesting they should remain accessible to patients.
Screening for diabetic retinopathy is recommended before starting GLP-1 receptor agonists, especially for individuals at high risk.
The risk of ocular complications should be discussed when prescribing GLP-1 receptor agonists to patients with existing sight loss or a history of non-arteritic anterior ischaemic optic neuropathy.
The consensus process revealed significant uncertainty regarding the relationship between GLP-1 receptor agonists and ocular complications.

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AIMS: There is current apprehension among some clinicians and conflicting evidence regarding ocular complications in relation to Glucagon-like peptide-1 receptor agonists (GLP-1RAs). We aimed to generate multi-disciplinary, expert-led consensus recommendations relating to ocular complications to facilitate optimum prescribing of GLP-1RAs.

MATERIALS AND METHODS: A modified Delphi was conducted following the ACcurate COnsensus Reporting Document (ACCORD) for Delphi research. A structured literature review informed an anonymous online Delphi questionnaire, followed by a virtual consensus meeting. Eligible participants included ophthalmologists, diabetologists, and obesity specialists practising in Europe.

RESULTS: Responses from 58 participants across 17 countries were analysed. Respondents agreed that diabetic retinopathy (DR) worsening events are primarily linked to rapid blood glucose-lowering, rather than a direct drug effect. The benefits of GLP-1RAs were deemed to outweigh potential ocular risks and should not limit access to these medicines. Prescribers should ensure that people with diabetes are screened for diabetic retinopathy before commencing GLP-1RAs, particularly in high-risk populations (>10 years duration and/or poor glucose control, (haemoglobin A1c [HbA1c] >10% or 86 mmol/mol)). When prescribing GLP-1RA to those with sight loss in one eye and/or prior history of non-arteritic anterior ischaemic optic neuropathy (NAION), the risk of ocular complications should be discussed. The Delphi study highlighted current uncertainty in the evidence, with some topics on the relationship between GLP-1RAs and ocular complications reaching limited consensus.

CONCLUSIONS: Further research is needed into the direct effects of GLP-1RAs on the retina and ocular complications. New evidence should be disseminated rapidly to optimise outcomes and safety.

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Addressing the risk of ocular complications of GLP ‐ 1RAs ; a multi‐disciplinary expert consensus

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