Exploring a Connection Between GLP-1 Drugs and Vision Loss

Two studies presented at the 2025 AAO Annual Meeting explored a possible connection between GLP-1 drugs and vision loss.

Using data from the World Health Organization’s global database of drug safety reports, researchers at the University of Ottawa Eye Institute, University of Toronto, McMaster University, and Doheny Eye Institute UCLA analyzed data on 117,173 patients with diabetes who were administering semaglutide (a GLP-1 receptor agonist), empagliflozin, exenatide, tirzepatide, or insulin. The study found that patients treated with semaglutide were 68.6 times more likely to develop nonarteritic anterior ischemic optic neuropathy (NAION) and eight times more likely to develop diabetic retinopathy than those administering empagliflozin, exenatide, insulin, or metformin. No significant association between tirzepatide (the active ingredient in other GLP-1 medications) and NAION or diabetic retinopathy.

In a separate study, researchers at the Cleveland Clinic Cole Eye Institute evaluated the effect of GLP-1 drugs on patients’ risk of developing age-related macular degeneration (AMD). The study analyzed data from more than 430,000 patients aged 50 years or older treated with a GLP-1, sodium-glucose cotransporter 2 inhibitors, metformin, or insulin to manage their diabetes for at least 2 years.

The 7,319 patients administering a GLP-1 for 5 years showed a significantly lower risk of developing dry AMD: 63% lower than patients treated with metformin, 58% lower than those treated with insulin, and 54% lower than those treated with sodium-glucose cotransporter 2 inhibitors. The protective effect increased among patients monitored for up to five years. The analysis showed no significant protection against the wet form of AMD.

Both groups of researchers concluded that more long-term studies are required to determine the effect of GLP-1 drugs on eye health. They also endorsed the conclusions of the AAO and the North American Neuro-Ophthalmology Society that patients who develop NAION while undergoing treatment with GLP-1 drugs should engage in shared decision-making with their physicians, including their ophthalmologist, neurologist, primary care physician, or endocrinologist. The discussion of whether to continue or discontinue GLP-1 drugs should consider the patient’s overall health, risk factors, and therapeutic options.