The eye in the era of GLP-1 receptor agonists ‒ a narrative review of current evidence

Abstract

Introduction and aim. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used in the treatment of type 2 diabetes and obesity. However, their effects on the visual system remain unclear. This narrative review summarizes current evidence and aims to clarify the association between GLP-1RAs and ocular outcomes.

Literature search. A literature search was conducted using PubMed/MEDLINE, Embase, and ScienceDirect electronic databases. Findings were grouped into thematic categories: diabetic retinopathy, NAION, AMD and other ocular events, and glaucoma.

Analysis of the literature. The available evidence is heterogeneous and sometimes conflicting. GLP-1RAs may be associated with diabetic retinopathy progression, particularly in patients with pre-existing type 2 diabetes, likely related to rapid glycemic improvement rather than direct drug toxicity. Reports of NAION remain rare, and causality has not been definitively established. The reviewed studies also indicate that GLP-1RAs may reduce AMD risk. Preclinical and observational studies suggest possible neuroprotective and intraocular pressure-lowering effects in glaucoma, while clinical evidence remain limited.

Conclusion. Current evidence does not indicate a consistent increase in major ophthalmic adverse outcomes associated with GLP-1RAs use. However, evidence remains limited and largely observational. Careful ophthalmic assessment and follow-up may be considered in high-risk individuals. Further prospective studies are needed to clarify causal relationships.