Keep Potential Eye Risks With GLP-1 Agonists in Sight

Patients will ask if GLP-1 agonists (semaglutide, etc) harm the eyes.

Most GLP-1 agonist labels already warn about diabetic retinopathy.

Now a study links GLP-1 agonists to neovascular (or “wet”) age-related macular degeneration (nAMD)...that can lead to central vision loss.

Another study suggests that semaglutide may increase the risk of nonarteritic ischemic anterior optic neuropathy (NAION)...or impaired blood flow to the optic nerve, which can lead to sudden loss of vision.

But explain that these findings are based on observational data...and put the risks in perspective, since both conditions are very rare.

For example, about 1 in 1,000 patients aged 66 or older with diabetes who use a GLP-1 agonist for at least 6 months may develop nAMD over 3 years...compared to similar patients not on these medications.

And about 1 additional case of NAION may occur in over 10,000 older patients with diabetes treated with semaglutide over 4 years...compared to non-GLP-1 agonist diabetes meds.

Be aware that the risk of these eye problems seems to go up with longer use. But it’s too soon to say if they’re more likely with certain GLP-1 agonists...or if dose, route, or frequency play a role.

Plus other data show conflicting results...or protective effects.

And diabetes itself is a risk factor for NAION and other eye issues.

Keep in mind that more research is needed in patients using GLP-1 agonists for obesity, obstructive sleep apnea, etc...and to determine why eye problems might occur. One theory is that GLP-1 agonists might reduce blood flow or oxygen levels in eyes if glucose levels decrease quickly.

For now, reassure that the benefits of GLP-1 agonists outweigh any rare ocular risks for most patients.

Get a baseline comprehensive eye exam before or within a month of starting a GLP-1...and reexamine at least annually.

Educate patients to watch for warning signs...report any changes in vision right away...and seek emergency care for vision loss.

For example, vision loss with NAION is often painless and develops in one eye over hours to days. nAMD usually occurs rapidly in one or both eyes...with blurred or distorted areas in the center of vision.

Check out our new interactive GLP-1 and GIP/GLP-1 Agonists Chart to create a customizable comparison of dosing, titration, A1c lowering, etc.

Stay tuned for our new GLP-1 Essentials CE program. Look for an announcement soon via email and on the Prescriber Insights home page.

• Chart: GLP-1 and GIP/GLP-1 Receptor Agonist Interactive Comparison Chart