Eyes on GLP-1: Impact on Ocular Health | Recording-Eyes on GLP-1: Impact on Ocular Health

Video Transcription

Video Summary

This ADA Eye Health Interest Group webinar, moderated by retina specialist Andrew Barkmeyer, featured Dr. Brian VanderBeek discussing whether GLP‑1 receptor agonists affect eye health. He reviewed three main concerns: non-arteritic ischemic optic neuropathy (NAION), age-related macular degeneration (AMD), and diabetic retinal disease (DRD).<br /><br />For NAION, an early clinic-based study suggested a high risk with semaglutide, but larger, higher-quality multi-database analyses found at most a very small absolute risk increase (about one extra case per 25,000 person-years). The practical conclusion was that this should not change prescribing patterns, though caution might be considered in the rare patient with prior NAION.<br /><br />For AMD, one Canadian study suggested increased risk of wet AMD, but multiple subsequent studies found no harm and possible protective effects, so no change in prescribing was recommended.<br /><br />For DRD, concern arose from the SUSTAIN‑6 trial showing more retinopathy complications with semaglutide, likely explained by “paradoxical worsening” after rapid A1C improvement. Observational studies using active comparators generally show no increased risk versus other diabetes drugs, with mixed findings depending on comparator choice. VanderBeek proposed a clinically relevant paradoxical worsening definition (progression to vision-threatening DRD) and showed risk rises with larger A1C drops, but absolute risk increases remain small (~1%). Overall: continue standard eye-exam schedules; advise evaluation for sustained vision changes; benefits of GLP‑1s outweigh rare risks.

Keywords

GLP-1 receptor agonists

semaglutide

eye health

non-arteritic ischemic optic neuropathy (NAION)

age-related macular degeneration (AMD)

diabetic retinal disease (DRD)

paradoxical worsening

SUSTAIN-6 trial

A1C reduction