Is there a link between medications like liraglutide (glucagon-like peptide-1 receptor agonist) or semaglutide (glucagon-like peptide-1 receptor agonist) and an increased risk of macular degeneration?

From the Guidelines

There is no established link between medications like liraglutide or semaglutide and an increased risk of macular degeneration. However, it's essential to consider the potential risks and benefits of these medications, particularly in patients with pre-existing eye conditions. According to the 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease 1, an increased risk of diabetic retinopathy complications has been noted with semaglutide, predominantly in patients with a prior history of proliferative retinopathy. This suggests that while there may not be a direct link to macular degeneration, patients with diabetes or pre-existing eye conditions should be closely monitored. Key points to consider include:

• The potential for rapid and sustained reductions in blood glucose with semaglutide, which may contribute to an increased risk of diabetic retinopathy complications 1
• The importance of regular eye examinations, especially for patients with diabetes or pre-existing eye conditions
• The need for patients to promptly consult their healthcare provider if they experience any new visual disturbances while on these medications It's crucial to weigh the benefits of GLP-1 receptor agonists, such as liraglutide and semaglutide, against the potential risks, particularly in patients with pre-existing eye conditions, and to closely monitor patients for any changes in their eye health 1.

From the FDA Drug Label

5.3 Diabetic Retinopathy Complications In a 2-year trial involving patients with type 2 diabetes and high cardiovascular risk, more events of diabetic retinopathy complications occurred in patients treated with OZEMPIC (3.0%) compared to placebo (1. 8%). The FDA drug label does not answer the question about macular degeneration.

From the Research

Medications and Macular Degeneration Risk

• The relationship between medications like liraglutide and semaglutide (glucagon-like peptide-1 receptor agonists) and the risk of macular degeneration is complex and has been investigated in several studies 2, 3, 4, 5, 6.
• A case report suggests that semaglutide may have a potential independent role in managing proliferative diabetic retinopathy, with a patient exhibiting resolution of neovascularisation and improved diabetic macular oedema within 6 weeks of semaglutide therapy 2.
• Another study found that liraglutide has a protective effect on diabetic retinal neurodegeneration by inhibiting oxidative stress and endoplasmic reticulum stress 3.
• However, a minireview notes that the SUSTAIN clinical trial program raised a safety issue concerning the progression and worsening of diabetic retinopathy with semaglutide use, although the exact mechanism is still debated 4.
• A retrospective matched cohort study found an association between semaglutide and an increased risk of nonarteritic anterior ischemic optic neuropathy (NAION) 5.
• A meta-analysis of randomized controlled trials found that semaglutide was not associated with an increased risk of diabetic retinopathy compared to controls, but subgroup analysis suggested an increased risk in older patients or those with long diabetes duration 6.

Key Findings

• Semaglutide may have a potential role in managing proliferative diabetic retinopathy 2.
• Liraglutide has a protective effect on diabetic retinal neurodegeneration 3.
• Semaglutide use may be associated with an increased risk of NAION 5.
• Older patients or those with long diabetes duration may be at increased risk of diabetic retinopathy when taking semaglutide 6.