In the Eye of Controversy: A Deeper Look Into the Impact of Glucagon-like Peptide-1 Receptor Agonists on Diabetic Retinopathy and Nonarteritic Anterior Ischemic Optic Neuropathy

Abstract

Glucagon-like peptide-1 receptor agonists (GLP1-RAs), a relatively new class of drugs, are used widely in treating type 2 diabetes mellitus and obesity. Maintaining long-term glycemic management lowers the risk of development and progression of diabetic retinopathy. However, recent literature has raised concerns about transient worsening of the condition with use of GLP1-RAs. In this review we evaluate the association between GLP1-RAs and retinopathy in patients with diabetes mellitus. We also analyzed the available evidence on the potential association between semaglutide therapy and nonarteritic anterior ischemic optic neuropathy (NAION). Our review consists of relevant publications, including meta-analyses, randomized controlled trials, and post hoc analyses, and outcomes of in vitro and in vivo research. The article search was conducted using several databases, including the WorldCat Discovery service provided by the Al Maktoum Medical Library, PubMed, and Google Scholar. Preclinical studies hint at possible protective effects on the retina, but a more complex picture is presented by clinical evidence. Although there have been cases of retinopathy development after GLP1-RA use, this may be due to a swift reduction in glycated hemoglobin 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: GLP1-RA; GLP1RA; agonistes du récepteur du peptide 1 similaire au glucagon; contrôle glycémique; diabetic retinopathy; diabète sucré de type 2; glucagon-like peptide-1 receptor agonists; glycemic management; neuropathie optique ischémique antérieure non artéritique; nonarteritic anterior ischemic optic neuropathy; rétinopathie diabétique; type 2 diabetes mellitus.