Overview

• Two large propensity-matched cohort analyses found about a 7% relative increase in new-onset diabetic retinopathy among GLP-1 agonist users, with an absolute rise of roughly 0.2% over two years.
• A national multicenter EHR study linked semaglutide and tirzepatide to a 1.76 hazard ratio for non-arteritic ischemic optic neuropathy, equating to NAION rates of 0.04% versus 0.02% in controls.
• In patients with preexisting diabetic retinopathy, GLP-1 therapies were not associated with higher progression to proliferative retinopathy or macular edema and corresponded with lower risks of severe outcomes including vision loss.
• The European Medicines Agency recently classified NAION as a very rare adverse reaction to semaglutide, leading to updated safety labeling for GLP-1 drugs across Europe.
• Investigators and clinical guidelines now call for baseline and periodic dilated eye exams, patient counseling on vision risks, and further mechanistic and randomized studies to clarify causation and risk modifiers.