Overview

• A JAMA Network Open analysis of 185,066 adults with type 2 diabetes found GLP-1 receptor agonist use carried a 7% higher hazard of new‐onset diabetic retinopathy (HR 1.07) with a small absolute increase over two years.
• Among 32,695 patients with existing retinopathy, GLP-1 agonists did not accelerate progression to proliferative disease or macular edema and were linked to a 24% lower risk of progression to blindness.
• In a separate cohort of 159,398 patients treated with semaglutide or tirzepatide, 35 cases of non-arteritic anterior ischemic optic neuropathy occurred versus 19 in controls, yielding an HR of 1.76 and absolute rates under 0.05% over two years.
• The European Medicines Agency now classifies NAION as a very rare adverse reaction for semaglutide and professional bodies recommend baseline and periodic dilated eye exams with targeted counseling for high-risk patients.
• Conflicting evidence from prior meta-analyses and smaller studies has driven demands for randomized and mechanistic research to clarify causality and refine ocular monitoring guidelines.