GLP-1 RAs Tied to Higher DR Risk, Lower Severe Complications

A recent study published in JAMA Network Open suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely used in the management of type 2 diabetes (T2D), may be associated with a slightly increased risk of incident diabetic retinopathy (DR), but also a reduced risk for certain severe DR-related complications.

Study Design and Patient Population

The study was led by David J. Ramsey, M.D., Ph.D., M.P.H., of the UMass Chan-Lahey School of Medicine in Burlington. Researchers conducted a retrospective cohort study involving adult patients with T2D and a recent hemoglobin A1c level ≥6.5%. Participants were divided into two matched groups based on prescription records for GLP-1 RAs, using propensity score matching.

A total of 185,066 patients were identified as having received GLP-1 RAs. The study aimed to evaluate the association between GLP-1 RA use and the development of DR, nonarteritic anterior ischemic optic neuropathy (NAION), and other DR complications.

Key Findings

Following analysis, researchers found that GLP-1 RA use was associated with a slight increase in the incidence of diabetic retinopathy (DR), with a hazard ratio (HR) of 1.07. However, no significant increase in the risk for nonarteritic anterior ischemic optic neuropathy (NAION) was observed.

Among a subgroup of 32,695 patients with preexisting DR, the use of GLP-1 RAs was not associated with a higher risk of proliferative DR or diabetic macular edema (DME). Importantly, the therapy was linked to a reduced risk of several severe DR complications, including vitreous hemorrhages (HR: 0.74), neovascular glaucoma (HR: 0.78), and blindness (HR: 0.77).

Clinical Implications

These findings underscore a nuanced profile for GLP-1 RAs in the context of diabetic eye disease. While there may be a modest increase in the initial development of DR, the therapies appear to reduce the risk of progression to more vision-threatening complications, even in patients with preexisting retinopathy.

“GLP-1 RAs may be a factor in reduced rates of vision loss leading to blindness, even among individuals with preexisting DR,” the authors noted.
“It is crucial that all patients with T2D treated with GLP-1 RAs, regardless of preexisting DR, receive regular screening and monitoring for potential complications of T2D.”

Reference:

David J. Ramsey et al, GLP-1 Receptor Agonists and Sight-Threatening Ophthalmic Complications in Patients With Type 2 Diabetes, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2025.26321