From the Guidelines
GLP-1 agonists have not been directly linked to blindness or permanent vision loss as common side effects, but patients with diabetes should be aware of the potential for rapid improvement in blood glucose control to temporarily worsen diabetic retinopathy, a phenomenon called "early worsening". This is not caused by the medication itself but by the rapid change in blood sugar levels, as noted in the 2025 standards of care in diabetes 1. Additionally, GLP-1 agonists may cause temporary vision changes like blurred vision in some patients as they adjust to the medication. If you experience any vision changes while taking a GLP-1 agonist, contact your healthcare provider immediately.
Some key points to consider when using GLP-1 agonists in patients with diabetes include:
- Regular eye exams are recommended for all patients with diabetes, including those on GLP-1 agonists, to monitor for any changes in vision or retinopathy.
- For patients with pre-existing diabetic retinopathy, healthcare providers may consider a more gradual improvement in glycemic control to minimize the risk of early worsening.
- The benefits of improved blood glucose control with GLP-1 agonists generally outweigh potential risks, as long-term poor glucose control is a major risk factor for permanent vision problems in diabetes, as discussed in the management of hyperglycemia in type 2 diabetes consensus report 1.
- GLP-1 receptor agonists have been shown to reduce albuminuria and slow eGFR decline, and may have benefits for patients with chronic kidney disease, as noted in the diabetes management in chronic kidney disease consensus report 1.
Overall, while GLP-1 agonists are not directly linked to blindness or permanent vision loss, patients with diabetes should be aware of the potential for rapid improvement in blood glucose control to temporarily worsen diabetic retinopathy, and regular eye exams are recommended to monitor for any changes in vision or retinopathy.
From the FDA Drug Label
• Diabetic Retinopathy Complications: Has been reported in a clinical trial. Patients with a history of diabetic retinopathy should be monitored (5.3). The GLP-1 agonist semaglutide may be associated with diabetic retinopathy complications, including potential loss of eyesight and blindness. Patients with a history of diabetic retinopathy should be monitored for these complications.
- Key points:
- Diabetic retinopathy complications have been reported in clinical trials
- Patients with a history of diabetic retinopathy should be monitored
- No direct information on the incidence of loss of eyesight and blindness is provided 2
From the Research
GLP-1 Agonist and Loss of Eyesight and Blindness
- The association between GLP-1 agonists and the risk of diabetic retinopathy has been evaluated in a disproportionality analysis using FDA adverse event reporting system data 3.
- The results showed a strong association between semaglutide and dulaglutide with diabetic retinopathy, with proportional reporting ratios (PRR) of 19.43 and 9.01, respectively 3.
- Tirzepatide and liraglutide also showed a weaker but significant association with diabetic retinopathy, while lixisenatide showed no significant association 3.
- These findings suggest that GLP-1 agonists, except lixisenatide, may be associated with an increased risk of diabetic retinopathy, which can lead to loss of eyesight and blindness if left untreated 3.
- However, it is essential to note that the exact mechanism of this association is not fully understood and requires further research to clarify the relationship between GLP-1 agonists and diabetic retinopathy 3.
Mechanism of Action
- GLP-1 agonists work by stimulating insulin secretion, suppressing glucagon secretion, and slowing gastric motility, which can help improve glycemic control in patients with type 2 diabetes 4, 5, 6, 7.
- They also have positive effects on beta-cell function and can lead to significant weight loss, making them a valuable treatment option for obese patients with type 2 diabetes 4, 5, 6, 7.
Clinical Implications
- The potential association between GLP-1 agonists and diabetic retinopathy highlights the need for close monitoring of patients taking these medications, particularly those with a history of diabetic retinopathy or other eye problems 3.
- Healthcare providers should be aware of the potential risks and benefits of GLP-1 agonists and carefully weigh these factors when making treatment decisions for patients with type 2 diabetes 3.