In The Eye Of Controversy: A Deeper Look Into The Impact Of Glucagon-Like Peptide 1 Receptor Agonists (GLP1RA) on Diabetic Retinopathy and Non-arteritic anterior ischemic optic neuropathy (NAION)

Abstract

Introduction: Glucagon-like peptide 1 receptor agonists (GLP1RA), a relatively new class of drugs, are widely used in treating type 2 diabetes mellitus and obesity. Maintaining long-term glycemic control lowers the risk of development and progression of diabetic retinopathy. However, recent literature has raised concerns about transient worsening of the condition with GLP1RA use.

Aim: This review aims to evaluate the association between GLP1RA and retinopathy in patients with diabetes mellitus. We also analyzed the available evidence on the potential association between Semaglutide therapy and non-arteritic anterior ischemic optic neuropathy (NAION).

Materials and methods: The review consists of relevant publications, including metanalysis, randomized control trials, and post-hoc analysis, including outcomes of in vitro and in vivo research. Article search was conducted using several databases, including the WorldCat Discovery service provided by Al Maktoum Medical Library, PubMed, and Google Scholar.

Conclusion: Preclinical studies hint at possible protective effects on the retina, but a more complex picture is presented by clinical evidence. While there have been cases of retinopathy development following GLP1RA use, this might be due to a swift reduction in HbA1C levels rather than the drug's mechanism of action itself. Evidence linking Semaglutide to NAION remains inconclusive and limited by methodological constraints. Large-scale studies with robust design are warranted to elucidate the potential association and to guide clinical practice.

Keywords: Diabetic Retinopathy; GLP1RA; Glucagon-like peptide 1 receptor agonists; Glycemic Control; Non-arteritic anterior ischemic optic neuropathy; Type 2 Diabetes Mellitus.