IRIS Registry-based Study Evaluates Side-Effect of Semaglutide Weight-Loss Drug on Diabetic Retinopathy

According to the American Academy of Ophthalmology (AAO), new review of real-world data offers reassurance for the use of the diabetes drug semaglutide, which is popular for helping people lower their glucose levels and better manage their weight. At issue has been that a potential side effect of the drug is vision loss.

The study found that most people taking semaglutide did not develop diabetic retinopathy or experience a worsening of existing diabetic retinopathy. The findings were presented at AAO 2023, the 127th annual meeting of the American Academy of Ophthalmology, held November 3-6 in San Francisco, California.

The lead investigator, Zeeshan Haq, MD, from Retina Consultants of Minnesota in Minneapolis-St. Paul, Minnesota, advised that further investigation is increasingly important since the FDA recently approved the use of semaglutide as a weight loss aid; so, ophthalmologists need more data to inform screening guidelines, monitoring schedules, and patient counseling.

As noted in the AAO press release, the effectiveness of semaglutide in causing a sudden drop in glucose levels is a concern. Previous studies have found a link between a rapid improvement in glucose control and the risk of worsening diabetic retinopathy. Although the increased risk is temporary and often manageable with current treatment protocols, this paradox warrants increased attention from ophthalmologists.

In the study, the investigators used AAO’s IRIS Registry to evaluate data from more than 48,000 adults with type 2 diabetes treated with injectable semaglutide. Patients in the study were between ages 51 and 75 year and were treated between 2013 and 2021.

The AAO press release summarized the study findings after 2 years of treatment:

• Only 2.2% of eyes with no or background diabetic retinopathy experienced a worsening of diabetic retinopathy.
• In eyes with early-stage disease (mild or moderate nonproliferative diabetic retinopathy), 3.5% of eyes showed a worsening of diabetic retinopathy.
• Approximately 60% of eyes with advanced disease (severe nonproliferative or proliferative diabetic retinopathy) experienced an improvement in their diabetic retinopathy.

Dr. Haq stated that although results are promising for people with diabetes hoping to use semaglutide for weight loss and other health benefits, more research is needed.

“This study has significant limitations including its retrospective observational design, lack of a control group, and a lack of pre- and postinitiation of semaglutide comparisons,” commented Dr. Haq in the AAO press release. “In particular, the impact of semaglutide initiation on short- and long-term outcomes in potentially high-risk patients, such as those with severe non-proliferative or proliferative diabetic retinopathy, should be investigated further. Ultimately, diabetic patients who are considering semaglutide should consult with their primary and eye care providers regarding their individual situation.”

AAO advised that researchers are working to learn more about the long-term effects of semaglutide on diabetic retinopathy in people with type 2 diabetes. The prospective FOCUS clinical trial, which will evaluate the long-term effects of semaglutide in addition to diabetes medication on diabetic retinopathy, is expected to conclude in February 2027.