What are the ocular effects of Glucagon-like peptide-1 (GLP-1) receptor agonists, such as liraglutide (Victoza) or semaglutide (Ozempic), in non-diabetic patients?

Ocular Effects of GLP-1 Receptor Agonists in Non-Diabetic Patients

GLP-1 receptor agonists may have both protective and adverse ocular effects in non-diabetic patients, with potential protective benefits against glaucoma, age-related macular degeneration, and dry eye disease due to their anti-inflammatory properties, while potentially increasing risk for nonarteritic ischemic optic neuropathy. 1

Potential Protective Ocular Effects

• Anti-inflammatory benefits: GLP-1 receptor agonists demonstrate significant anti-inflammatory effects that may provide protection against certain eye conditions 1:

  • Reduced risk of glaucoma
  • Protective effects against age-related macular degeneration (AMD)
  • Improvement in dry eye disease symptoms

• Intracranial pressure reduction: These medications may decrease intracranial pressure in idiopathic intracranial hypertension (IIH), which could benefit optic nerve health 1

Potential Adverse Ocular Effects

• Nonarteritic ischemic optic neuropathy (NAION): GLP-1 receptor agonists may be associated with increased risk of NAION, though the exact mechanism remains unclear 1

• Rapid weight loss considerations: The significant weight loss associated with GLP-1 receptor agonists (6.1-17.4% in non-diabetics) 2 could potentially affect ocular structures through:

  • Changes in orbital fat composition
  • Alterations in intraocular pressure

Monitoring Recommendations

• Regular ophthalmologic follow-up is important for non-diabetic patients on GLP-1 receptor agonists, particularly those considered at higher risk for ocular adverse events 1

• Special attention should be paid to patients with:

  • Pre-existing eye conditions
  • Risk factors for NAION (small optic disc, sleep apnea, hypertension)
  • Rapid weight loss (>10% of body weight)

Clinical Context

• GLP-1 receptor agonists have shown substantial weight loss benefits in non-diabetic patients:

  • Semaglutide 2.4mg weekly reduced mean body weight by 14.9% in non-diabetic overweight/obese patients 2
  • Tirzepatide (dual GIP/GLP-1 receptor agonist) resulted in 15% weight loss at 72 weeks, with higher doses (15mg) achieving 20.9% weight loss 2

• The cardiovascular benefits seen in diabetic patients also extend to non-diabetics:

  • In non-diabetic patients with pre-existing cardiovascular disease and BMI >27, semaglutide 2.4mg weekly reduced cardiovascular endpoints compared to placebo (6.5% vs 8.2%, p=0.001) 2

Risk Management

• Start GLP-1 receptor agonists at low doses and titrate upward slowly to minimize adverse effects 2

• Consider baseline ophthalmologic examination before initiating therapy in high-risk patients

• Educate patients about potential ocular symptoms that warrant prompt evaluation:

  • Sudden vision changes
  • Eye pain
  • Visual field defects

Conclusion

While the systemic benefits of GLP-1 receptor agonists in non-diabetic patients are well-established, their ocular effects represent a mixed profile of potential benefits and risks. Current evidence suggests that these medications should generally not be discouraged based on ocular concerns alone, but appropriate monitoring is warranted, especially in high-risk patients 1.