Semaglutide and the Retina
Zachary T. Bloomgarden,
Corresponding Author
Zachary T. Bloomgarden
Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Correspondence:
Zachary T. Bloomgarden ([email protected])
Search for more papers by this authorZachary T. Bloomgarden,
Corresponding Author
Zachary T. Bloomgarden
Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Correspondence:
Zachary T. Bloomgarden ([email protected])
Search for more papers by this authorFirst published: 14 April 2025
Funding: The author received no specific funding for this work.
Conflicts of Interest
The author declares no conflicts of interest.
References
- 1Z. L. Teo, Y. C. Tham, M. Yu, et al., “Global Prevalence of Diabetic Retinopathy and Projection of Burden Through 2045: Systematic Review and Meta-Analysis,” Ophthalmology 128, no. 11 (2021): 1580–1591.
- 2A. King, X. Tan, N. Dhopeshwarkar, et al., “Recent Trends in GLP-1 RA and SGLT2i Use Among People With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease in the USA,” BMJ Open Diabetes Research & Care 12, no. 5 (2024): e004431.
- 3A. Montero, G. Sparks, M. Presiado, and L. Hamel, “KFF Health Tracking Poll May 2024: The Public's Use and Views of GLP-1 Drugs,” 2025, https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-may-2024-the-publics-use-and-views-of-glp-1-drugs/.
- 4S. K. Kunutsor, V. G. Balasubramanian, F. Zaccardi, et al., “Glycaemic Control and Macrovascular and Microvascular Outcomes. A Systematic Review and Meta-Analysis of Trials Investigating Intensive Glucose-Lowering Strategies in People With Type 2 Diabetes,” Diabetes, Obesity & Metabolism 26, no. 6 (2024): 2069–2081.
- 5Z. Bloomgarden, “Is Insulin the Preferred Treatment for HbA1c >9%?,” Journal of Diabetes 9, no. 9 (2017): 814–816.
- 6J. G. Llewelyn, P. K. Thomas, V. Fonseca, R. H. King, and P. Dandona, “Acute Painful Diabetic Neuropathy Precipitated by Strict Glycaemic Control,” Acta Neuropathologica 72, no. 2 (1986): 157–163.
- 7 The Diabetes Control and Complications Trial Research Group, “Early Worsening of Diabetic Retinopathy in the Diabetes Control and Complications Trial,” Archives of Ophthalmology 116 (1998): 874–886.
- 8A. Eleftheriadou, D. Riley, S. S. Zhao, et al., “Risk of Diabetic Retinopathy and Diabetic Macular Oedema With Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide 1 Receptor Agonists in Type 2 Diabetes: A Real-World Data Study From a Global Federated Database,” Diabetologia 67, no. 7 (2024): 1271–1282.
- 9J. Muayad, A. Loya, Z. S. Hussain, et al., “Influence of Common Medications on Diabetic Macular Edema in Type 2 Diabetes Mellitus,” Ophthalmology Retina (2025), https://doi.org/10.1016/j.oret.2024.12.006.
- 10D. S. Lin, H. Y. Lo, K. C. Huang, T. T. Lin, J. K. Lee, and L. Y. Lin, “Incidence and Progression of Diabetic Retinopathy in Patients Treated With Glucagon-Like Peptide-1 Receptor Agonists Versus Sodium-Glucose Cotransporter 2 Inhibitors: A Population-Based Cohort Study,” Diabetes, Obesity & Metabolism 26, no. 10 (2024): 4386–4396.
- 11J. Hasselstrøm Jensen, P. Vestergaard, and J. M. Hasselstrøm, “Association Between Glucose-Lowering Treatments and Risk of Diabetic Retinopathy in People With Type 2 Diabetes: A Nationwide Cohort Study,” Current Drug Safety 19, no. 2 (2024): 236–243.
- 12J. H. Joo, N. Sharma, J. Shaia, et al., “The Effect of Glucagon-Like Peptide-1 Receptor Agonists on Diabetic Retinopathy at a Tertiary Care Center,” Ophthalmology Science 4, no. 6 (2024): 100547.
- 13J. Zhou, W. Huang, Y. Xie, H. Shen, M. Liu, and X. Wu, “Risk of Ophthalmic Adverse Drug Reactions in Patients Prescribed Glucagon-Like Peptide 1 Receptor Agonists: A Pharmacovigilance Study Based on the FDA Adverse Event Reporting System Database,” Endocrine 88 (2025): 80–90, https://doi.org/10.1007/s12020-024-04112-8.
- 14S. P. Marso, S. C. Bain, A. Consoli, et al., “Semaglutide and Cardiovascular Outcomes in Patients With Type 2 Diabetes,” New England Journal of Medicine 375, no. 19 (2016): 1834–1844.
- 15T. Vilsbøll, S. C. Bain, L. A. Leiter, et al., “Semaglutide, Reduction in Glycated Haemoglobin and the Risk of Diabetic Retinopathy,” Diabetes, Obesity & Metabolism 20, no. 4 (2018): 889–897.
- 16A. Małyszczak, J. Przeździecka-Dołyk, U. Szydełko-Paśko, and M. Misiuk-Hojło, “Novel Antidiabetic Drugs and the Risk of Diabetic Retinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” Journal of Clinical Medicine 13, no. 6 (2024): 1797.
- 17X. Jiao, P. Peng, Q. Zhang, and Y. Shen, “Glucagon-Like Peptide-1 Receptor Agonist and Risk of Diabetic Retinopathy in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials,” Clinical Drug Investigation 43, no. 12 (2023): 915–926.
- 18S. G. Albert, E. M. Wood, and V. Ahir, “Glucagon-Like Peptide 1-Receptor Agonists and A1c: Good for the Heart but Less So for the Eyes?,” Diabetes and Metabolic Syndrome: Clinical Research and Reviews 17, no. 1 (2023): 102696.
- 19M. A. Bethel, R. Diaz, N. Castellana, I. Bhattacharya, H. C. Gerstein, and M. C. Lakshmanan, “HbA1c Change and Diabetic Retinopathy During GLP-1 Receptor Agonist Cardiovascular Outcome Trials: A Meta-Analysis and Meta-Regression,” Diabetes Care 44, no. 1 (2021): 290–296.
- 20I. Kapoor, S. M. Sarvepalli, D. D'Alessio, D. S. Grewal, and M. Hadziahmetovic, “GLP-1 Receptor Agonists and Diabetic Retinopathy: A Meta-Analysis of Randomized Clinical Trials,” Survey of Ophthalmology 68, no. 6 (2023): 1071–1083.
- 21I. Kapoor, S. M. Sarvepalli, D. A. D'Alessio, and M. Hadziahmetovic, “Impact of Glucagon-Like Peptide-1 Receptor Agonists on Diabetic Retinopathy: A Meta-Analysis of Clinical Studies Emphasising Retinal Changes as a Primary Outcome,” Clinical & Experimental Ophthalmology 53 (2025): 67–75, https://doi.org/10.1111/ceo.14445.
- 22F. Wang, Y. Mao, H. Wang, Y. Liu, and P. Huang, “Semaglutide and Diabetic Retinopathy Risk in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials,” Clinical Drug Investigation 42, no. 1 (2022): 17–28.
- 23M. L. Salvetat, F. Pellegrini, L. Spadea, C. Salati, and M. Zeppieri, “Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview,” Vision (Basel) 7, no. 4 (2023): 72.
- 24B. J. Katz, M. S. Lee, N. S. Lincoff, et al., “Ophthalmic Complications Associated With the Antidiabetic Drugs Semaglutide and Tirzepatide,” JAMA Ophthalmology 30 (2025): e246058.
- 25J. T. Hathaway, M. P. Shah, D. B. Hathaway, et al., “Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide,” JAMA Ophthalmology 142, no. 8 (2024): 732–739.
- 26J. Grauslund, A. A. Taha, L. D. Molander, et al., “Once-Weekly Semaglutide Doubles the Five-Year Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in a Danish Cohort of 424,152 Persons With Type 2 Diabetes,” International Journal of Retina and Vitreous 10, no. 1 (2024): 97.
- 27E. Simonsen, L. C. Lund, M. T. Ernst, et al., “Use of Semaglutide and Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Danish–Norwegian Cohort Study,” Diabetes, Obesity & Metabolism (2025), https://doi.org/10.1101/2024.12.09.24318574.
- 28C. C. Chou, S. Y. Pan, Y. J. Sheen, et al., “Association Between Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy: A Multinational Population-Based Study,” Ophthalmology 132, no. 4 (2024): 381–388, https://doi.org/10.1001/jamaophthalmol.2025.0349.
- 29D. C. Klonoff, G. Hui, and S. Gombar, “Real-World Evidence Assessment of the Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide,” Journal of Diabetes Science and Technology 18, no. 6 (2024): 1517–1518.
- 30A. Y. Hsu, H. T. Kuo, Y. H. Wang, et al., “Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy Risk Among Patients With Diabetes,” JAMA Ophthalmology (2025): e250349, https://doi.org/10.1001/jamaophthalmol.2025.0349.
- 31D. S. Popovic, D. Patoulias, P. Karakasis, T. Koufakis, and N. Papanas, “Effect of Tirzepatide on the Risk of Diabetic Retinopathy in Type 2 Diabetes,” Diabetes, Obesity & Metabolism 26, no. 6 (2024): 2497–2500.
- 32R. Rajagopal and J. B. McGill, “Novel Agents in the Management of Diabetes and Risk of Worsening Diabetic Retinopathy,” Retina 44, no. 11 (2024): 1851–1859.
