Beyond Glycemic Control: Ocular Effects of Glucagon-like Peptide-1 Receptor Agonists.

This review examines the ocular effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual-incretin therapies, which are increasingly used for diabetes and obesity management. The authors synthesize experimental and clinical evidence across multiple ocular conditions. Preclinical data suggest plausible protective mechanisms, including antioxidant and neuroprotective effects on retinal and optic nerve tissues. In diabetic retinopathy, the review identifies transient early worsening as a key concern, attributed to rapid glycemic improvement rather than direct drug toxicity. A potential signal linking semaglutide to non-arteritic anterior ischemic optic neuropathy (NAION) is noted, though the authors characterize absolute risk as low and causality as unproven. Emerging associations are discussed for glaucoma, ocular surface diseases, and retinal vascular outcomes, while evidence on age-related macular degeneration and cataract is described as conflicting or preliminary. The authors conclude that ocular outcomes likely reflect an interplay of drug pharmacology, systemic metabolic changes, and individual patient factors rather than a uniform class effect. They suggest baseline ophthalmic assessment and individualized follow-up for high-risk patients, and call for prospective ophthalmology-focused trials. A key limitation is its reliance on heterogeneous and largely indirect evidence.

Why this grade: This is a narrative review synthesizing heterogeneous experimental and clinical data; it does not generate primary evidence and its conclusions are limited by the quality and consistency of the underlying studies.