The findings of two unrelated studies published in JAMA Open Network on Monday suggest that all patients using GLP-1 receptor agonists to treat type 2 diabetes should undergo regular screening and monitoring for potential ophthalmic complications, given the potential ophthalmic risks involved.
Studying GLP-1 use in patients with type 2 diabetes (T2D)
In the five-year study, researchers examined a cohort of 159,398 patients with T2D who had no prior eye disorders. They found that the use of GLP-1 receptor agonists (RAs) — including semaglutide (marketed by Novo Nordisk as Ozempic and Wegovy) or tirzepatide (branded by Eli Lilly as Mounjaro and Zepbound) — was associated with a minimally increased risk of nonarteritic anterior ischemic optic neuropathy (NAION) and other optic nerve disorders.
For context, 35 patients (0.04%) taking semaglutide or tirzepatide developed NAION, compared to 19 (0.02%) using other non-GLP-1 antidiabetic medications.
The other cohort analysis followed 185,066 adults with T2D and a recent hemoglobin A1c level of 6.5% or higher for two years after starting semaglutide, lixisenatide, tirzepatide, dulaglutide, liraglutide, or exenatide to determine if GLP-1 RA therapies are associated with risks of developing NAION, diabetic retinopathy (DR) or other related sight-threatening complications.
The findings of this study indicate that, although GLP-1 RA use was linked to a modest increase in new-onset DR, fewer patients progressed to sight-threatening stages, developed related complications or required invasive treatment. The results suggest GLP-1 RAs might help lower the rate of vision loss leading to blindness, even in those with pre-existing DR.
Clinical implications
While the studies reveal potential ophthalmic risks, these findings do not warrant halting GLP-1 RA therapy for patients with T2D. Instead, the researchers recommend closer monitoring to help detect visual complications early and identify which patients might benefit from more targeted screening.
“It is crucial that all patients with T2D treated with GLP-1 RAs, regardless of pre-existing DR, receive regular screening and monitoring for potential complications of T2D,” the authors of the two-year study said.
The authors of the other study called for further research to investigate possible causes, pinpoint high-risk patient groups and assess other related conditions. Additional data could lead to more personalized monitoring plans aimed at protecting GLP-1 RA users with T2D.
Alivia Kaylor is a scientist and the senior site editor of Pharma Life Sciences.