Clinical Scorecard: Electroretinography in Diabetic Retinopathy: A Case Study

At a Glance

Key Highlights

• ERG can objectively measure retinal functional impairment and predict risk of intervention in DR.
• GLP-1 agonists, used for type 2 diabetes and weight loss, may increase risk of DR complications.
• Close monitoring and collaboration with primary care and retina specialists are essential for managing DR progression.

Guideline-Based Recommendations

Diagnosis

• Perform comprehensive retinal examination including fundus imaging to identify hemorrhages, cotton-wool spots, and exudates.
• Use handheld electroretinography to assess implicit time and amplitude for functional retinal assessment and risk stratification.

Management

• Advise patients on strict glycemic control and lifestyle modifications including diet and exercise.
• Refer patients with worsening DR or macular edema risk to retina specialists for further evaluation and treatment.
• Monitor patients on GLP-1 agonists closely for potential DR progression.

Monitoring & Follow-up

• Schedule follow-up eye exams every 4 to 6 months for patients with moderate to severe DR.
• Repeat ERG assessments to track retinal function changes over time.
• Coordinate with primary care providers to monitor systemic diabetes control and medication adherence.

Risks

• Poor glycemic control leading to DR progression and vision loss.
• Potential DR worsening associated with GLP-1 agonist therapy.
• Delayed follow-up and treatment increasing risk of severe retinal damage.

Patient & Prescribing Data

Middle-aged adults with type 2 diabetes and retinal findings suggestive of DR

Metformin and GLP-1 agonists improve glycemic control; however, GLP-1 agonists may be linked to increased DR complications necessitating vigilant ocular monitoring.

Clinical Best Practices

• Educate patients on the importance of regular eye exams and systemic disease management.
• Utilize ERG as an adjunctive tool to detect functional retinal changes not visible on fundus exam alone.
• Maintain interdisciplinary communication between eye care providers and primary care or endocrinology teams.
• Screen patients before initiating GLP-1 agonists and monitor retinal status closely during therapy.
• Promptly refer patients with signs of macular edema or severe DR to retina specialists.

References

• Marso SP et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016
• Singh H et al. Association between GLP-1 agonists and risk of diabetic retinopathy. Expert Rev Endocrinol Metab. 2025