What is the relationship between Glucagon-like peptide-1 (GLP-1) and ocular health?

From the Guidelines

GLP-1 receptor agonists are generally safe for the eyes, but patients with diabetes should be aware of potential concerns, including the risk of worsening retinopathy with rapid blood sugar improvement, and should have regular eye exams, especially if they have pre-existing eye conditions, as recommended by the American Diabetes Association in 2025 1. When considering the use of GLP-1 receptor agonists, such as semaglutide or dulaglutide, it is essential to weigh the potential benefits of improved blood sugar control against the potential risks to the eyes.

• The American Diabetes Association recommends implementing strategies to help people with diabetes reach glycemic goals to reduce the risk or slow the progression of diabetic retinopathy 1.
• A meta-analysis of data from cardiovascular outcomes studies showed no association between GLP-1 RA treatment and retinopathy per se, except through the association between retinopathy and average A1C reduction at the 3-month and 1-year follow-up 1.
• However, GLP-1 RAs, including liraglutide, semaglutide, and dulaglutide, have been shown to be effective in improving glycemic control, which can help reduce the risk of diabetic retinopathy progression 1.
• Patients starting GLP-1 medication should have a baseline eye exam, especially if they have diabetes or pre-existing eye conditions, and should report any new visual symptoms to their doctor promptly, as advised by the American College of Cardiology in 2020 1.
• Regular eye exams are crucial for diabetic patients on these medications to monitor for any potential issues and address them early, as recommended by the American College of Cardiology in 2018 1.

From the Research

GLP-1 and Eyes

• The relationship between GLP-1 and eyes is complex, with some studies suggesting a potential protective effect of GLP-1 agonists on external eye diseases, such as dry eye disease (DED) and superficial keratitis 2.
• However, other studies have found that GLP-1 receptor agonists may be associated with an increased risk of diabetic retinopathy (DR) complications, particularly in the early stages of the disease 3, 4.
• The expression of GLP-1 receptors in the human eye is low, and it is not detected in eyes with advanced stages of proliferative diabetic retinopathy (PDR) 3.
• The use of GLP-1 receptor agonists, such as albiglutide, may be associated with a higher risk of early-stage DR, but also with a lower risk of late-stage DR compared to insulin 4.
• The influence of GLP-1 receptor agonists on DR and the eye may depend on the specific GLP-1 receptor agonist and patient demographic and clinical characteristics 4.

External Eye Diseases

• GLP-1 agonist treatments are significantly associated with a lower incidence of subsequent DED and superficial keratitis 2.
• The correlation between GLP-1 agonist and DED development is more prominent in patients younger than 60 years old 2.
• The relationship between GLP-1 agonist usage and infectious keratitis is not significant 2.

Diabetic Retinopathy

• GLP-1 receptor agonists may have a beneficial effect on preventing or arresting experimental DR, but the results of clinical trials are neutral or worse compared to placebo 5.
• The use of GLP-1 receptor agonists is associated with an increased risk of early-stage DR, but also with a lower risk of late-stage DR compared to insulin 4.
• The expression of GLP-1 receptors in the human eye is low, and it is not detected in eyes with advanced stages of PDR 3.