Objective:

To inform about the ocular complications associated with GLP-1 receptor agonists (RAs) and emphasize the critical role of baseline eye examinations in preventing adverse outcomes.

Key Findings:

• Rapid A1C reduction may worsen DR early, but this is not due to GLP-1 RAs themselves; understanding this is crucial for patient management.
• In the SUSTAIN-6 trial, 3% of semaglutide users developed DR complications compared to 1.8% on placebo, indicating a need for careful monitoring.
• Tirzepatide is linked to higher odds of proliferative DR in patients with moderate nonproliferative DR and diabetic macular edema (DME), necessitating vigilance in these populations.
• Semaglutide users have an increased risk of NAION, particularly in T2DM and obesity cohorts, highlighting the importance of patient education on symptoms.
• Wet AMD risk is slightly higher among GLP-1 RA users, especially with prolonged use, warranting ongoing assessment.

Interpretation:

While GLP-1 RAs have associated ocular risks, the benefits of A1C reduction and cardiovascular risk management currently outweigh these risks, underscoring the need for informed patient discussions.

Limitations:

• Limited data on liraglutide's association with NAION; further studies are essential to clarify this relationship.
• Need for more research to establish definitive conclusions regarding wet AMD risks, which could impact treatment guidelines.

Conclusion:

Regular monitoring and patient education on ocular signs are crucial for those on GLP-1 RAs, especially for individuals with preexisting DR, to ensure timely intervention.