The Benefits and Risks of Glucagon-Like Peptide-1 Receptor Agonists on Ocular Diseases: A Narrative Review

TL;DR

This review examines how GLP-1RAs, used for diabetes and obesity, may both help and harm eye health, highlighting the need for careful monitoring.

Contribution

The paper systematically reviews emerging evidence on the ocular benefits and risks of GLP-1RAs, offering insights for safer clinical use.

Findings

GLP-1RAs may worsen retinal vascular occlusion and diabetic retinopathy.

They show potential benefits for glaucoma and idiopathic intracranial hypertension.

Adverse effects may involve retinal microvascular dysregulation and oxidative stress.

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are incretin-based agents used in the management of type 2 diabetes mellitus (T2DM) and obesity. This class of medications mimics the action of the endogenous GLP-1 hormone, enhances insulin secretion, delays gastric emptying, causes early satiety, lowers systemic glycemic levels, and results in weight loss. There are emerging concerns about the use of GLP-1RAs, which may be an observational association with ocular pathologies, including retinal vascular occlusion (RVO), vitreous hemorrhage (VH), diabetic retinopathy (DR), non-arteritic ischemic optic neuropathy (NAION), and diabetic macular edema (DME). In contrast, there are beneficial impacts of GLP-1RAs on various conditions, including glaucoma and idiopathic intracranial hypertension. This narrative review aims to analyze current findings on the beneficial and adverse ocular effects of GLP-1RAs use, highlighting studies that elucidate the harmful causes, such as retinal microvascular dysregulation, inflammatory modulation, oxidative stress, osmotic dysregulation from sorbitol accumulation, and metabolic shifts. The literature search was conducted using PubMed, Elsevier, Embase, Google Scholar, Scopus, and Science Direct to retrieve relevant literature published in peer-reviewed journals from 2014 to 2025. Understanding the benefits and risks of GLP-1RAs in ophthalmology is crucial for clinicians to manage ocular conditions safely while a patient is using GLP-1RAs, and enables personalized ophthalmological screenings to minimize the risk of disease exacerbation.

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