Journal of the Chinese Medical Association : JCMAMar 20, 2026

Eye problems linked to glucagon-like peptide-1 receptor agonist drugs: Evidence, possible causes, and medical advice

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 21, 2026

Abstract

Clinical trial data show a higher incidence of diabetic retinopathy complications with semaglutide in patients with pre-existing conditions.

SUSTAIN-6 reported early worsening of diabetic retinopathy with semaglutide, particularly in patients with rapid HbA1c reduction.
The REWIND and LEADER trials found no significant increase in diabetic retinopathy, indicating variability among GLP-1 receptor agonists.
Observational studies present mixed results on diabetic retinopathy progression risks, with some suggesting an increased risk in vulnerable populations.
GLP-1 receptor agonists, particularly semaglutide, have been linked to nonarteritic anterior ischemic optic neuropathy, classified as a very rare adverse effect.
Real-world data indicate potential protective associations of GLP-1 receptor agonists with certain retinal disorders, although findings are inconsistent.
Ocular risks may be more pronounced in high-risk groups, emphasizing the need for individualized prescribing and monitoring.

Simplified

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs)-central to type 2 diabetes mellitus (T2DM) management owing to their comprehensive benefits (glycemic control, weight reduction, cardiovascular benefits, and renal protection)-exhibit a concerning ocular safety profile. Clinical trial data, notably from SUSTAIN-6, revealed a higher incidence of diabetic retinopathy (DR) complications with semaglutide, particularly in patients with pre-existing DR and rapid HbA1c reduction, reflecting early worsening. Conversely, the REWIND and LEADER trials reported no significant DR, suggesting variability among agents and the potential influence of glycemic trajectory. Observational studies and meta-analyses provide mixed findings: some suggest increased DR progression risk in vulnerable populations, while others indicate a lower risk than insulin therapy. Beyond DR, recent pharmacoepidemiologic studies and pharmacovigilance reports have implicated GLP-1 RAs-especially semaglutide-in nonarteritic anterior ischemic optic neuropathy (NAION), leading the European Medicines Agency to classify NAION as a very rare adverse effect and prompting regulatory scrutiny. Conversely, real-world data suggest possible protective associations with other retinal disorders, including reduced incidence of neovascular age-related macular degeneration and diabetic macular edema, although findings remain inconsistent. The mechanistic pathways involve rapid metabolic shifts, vascular dysregulation, and potentially direct effects on retinal or optic nerve tissue. While GLP-1 RAs confer substantial systemic benefits, their ocular risks appear concentrated in high-risk subgroups. Individualized prescribing, baseline ophthalmic assessment, and interdisciplinary monitoring are essential until ongoing prospective trials clarify their long-term ocular impact.

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Competing interests

Conflicts of interest: Dr. Harn-Shen Chen, an editorial board member at Journal of the Chinese Medical Association , had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.

PubMed

Eye problems linked to glucagon-like peptide-1 receptor agonist drugs: Evidence, possible causes, and medical advice

Abstract

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Competing interests

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Abstract

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