JAMA Netw Open

GLP-1 receptor agonists linked to modest increase in diabetic retinopathy but fewer sight-threatening complications

August 13, 2025

Study details: This retrospective cohort study analyzed data from 185,066 adults with T2DM and HbA1c ≥6.5%, using the TriNetX database (2015–2022). Patients were divided into GLP-1 RA users and non-users via propensity score matching. Primary outcomes: incident diabetic retinopathy (DR), nonarteritic anterior ischemic optic neuropathy (NAION), and sight-threatening DR complications over a 2-year follow-up.

Results: GLP-1 RA use was associated with a modest increase in incident DR (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03-1.11), but no significant rise in NAION risk (HR, 1.26; 95% CI, 0.94-1.70). Among 32,695 patients with preexisting DR, GLP-1 RA use was linked to lower rates of vitreous hemorrhage (HR, 0.74), neovascular glaucoma (HR, 0.78), and blindness (HR, 0.77). No increased risk was found for progression to proliferative DR or diabetic macular edema.

Clinical impact: While GLP-1 RAs may slightly elevate the risk of developing DR, they appear protective against severe vision-threatening outcomes. These findings support continued use of GLP-1 RAs in T2DM patients, with emphasis on regular ophthalmic screening regardless of DR status.

Source:

Ramsey DJ, et al. (2025, August 1). JAMA Netw Open. GLP-1 Receptor Agonists and Sight-Threatening Ophthalmic Complications in Patients With Type 2 Diabetes. https://pubmed.ncbi.nlm.nih.gov/40788647/