GLP may be linked to double the risk for macular degeneration

[missy]

GLP-1 RAs Linked to Doubled Risk for Macular Degeneration​

Edited by Jake Remaly
June 05, 2025

TOPLINE:​

Patients with diabetes using glucagon-like peptide 1 receptor agonists (GLP-1 RAs) may face more than twice the risk for developing neovascular age-related macular degeneration compared with those not using the medications, data from Canada showed. The risk appears to increase with longer exposure to the drugs.

METHODOLOGY:​

• Researchers conducted a population-based, retrospective cohort study using administrative data for 139,002 patients aged 66 years or older in Ontario, Canada, from January 2020 to November 2023.
• The researchers matched 46,334 patients who had received a GLP-1 agent (predominantly semaglutide) for at least 6 months 1:2 with patients who had not received this type of medication, based on factors such as age, gender, duration of diabetes, and comorbidities.
• They examined the incidence of new diagnoses of neovascular age-related macular degeneration during 3 years of follow-up.

TAKEAWAY:​

• Patients exposed to GLP-1 RAs showed a higher incidence of neovascular age-related macular degeneration than unexposed patients (0.2% vs 0.1%).
• Both unadjusted and adjusted Cox proportional hazard models estimated higher risk for neovascular age-related macular degeneration among patients exposed to GLP-1 medication (hazard ratio
  

 

[missy]

Weird I cannot post the full article in one post so here it is continued​

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IN PRACTICE:​

“GLP-1 RAs have had a tremendous role in the care of patients with diabetes and now those needing additional help with weight management. However, the adage that ‘there is no such thing as a free lunch’ remains true,” wrote Brian L. VanderBeek, MD, MPH, with the Scheie Eye Institute at the University of Pennsylvania Perelman School of Medicine, Philadelphia, in an editorialaccompanying the study. “While certainly not outweighing the good these medications offer, prescribing physicians need to keep in mind the real and serious ocular adverse events that may occur.”

SOURCE:​

Rajeev H. Muni, MD, with St. Michael’s Hospital in Toronto, Ontario, was the corresponding author of the study, which was published online on June 5 in JAMA Ophthalmology.

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LIMITATIONS:​

The analysis did not stratify results by the type of GLP-1 RA prescribed or consider dose, route of administration, or frequency of administration. The researchers had limited information about variables like smoking and sun exposure. “Further research is needed to determine if there is a true cause and effect relationship,” the study authors wrote.

 

[missy]

Eye Complications Found With Use of Semaglutide, Tirzepatide​

Edited by Shrabasti Bhattacharya

TOPLINE:​

At least nine patients using the glucagon-like peptide 1 (GLP-1) receptor agonists semaglutide and tirzepatide developed ophthalmic complications, of whom seven had nonarteritic anterior ischemic optic neuropathy (NAION), according to a case series. Researchers hypothesize that rapid correction of hyperglycemia induced by these drugs may be associated with the eye disorders.

METHODOLOGY:​

• Researchers reported on nine patients (mean age, 57.4 years; 56% women) who developed ophthalmic complications while using semaglutide (n = 6) or tirzepatide (n = 3).
• All patients were initially seen in a community setting and had never used GLP-1 drugs or any other medications associated with optic neuropathies or retinopathies within the year before the onset of symptoms.
• The patients had a history of type 2 diabetes, hyperlipidemia, hypertension, and/or sleep apnea.
• Analysis included visual acuity measurements and visual field defect assessments as main outcome measures.

TAKEAWAY:​

• While receiving treatment with semaglutide or tirzepatide, seven patients developed NAION, one patient developed bilateral papillitis, and one developed paracentral acute middle maculopathy.
• Among the seven patients with NAION, some experienced atypical symptoms such as sequential ION, swelling of the optic nerve head in both eyes at presentation, and progressive loss of vision.
• The single patient who developed bilateral diabetic papillitis with semaglutide therapy did not end up losing vision and continued receiving the GLP-1 agent.
• The researchers hypothesized that rapid correction of hyperglycemia induced by these drugs, rather than direct toxicity of the medications, could be associated with the reported ophthalmic complications.

IN PRACTICE:​

“The [American Academy of Ophthalmology] has not recommended that patients stop using semaglutide, but rather, that patients experiencing vision loss while taking semaglutide should stop the drug and contact the physician prescribing the medication,” the authors of the study wrote. Clinicians who prescribe GLP-1 drugs to their patients with diabetes “should consider a drug regimen that more gradually lowers the A1c level,” they added.

“It is estimated that by 2030, 30 million GLP-1 RA prescriptions will have been dispensed in the US. Despite the rarity of NAION, the large number of users of these drugs can translate to a significant number of NAION cases. Future epidemiologic studies with robust methods are urgently needed to accurately quantify this risk,” experts wrote in an accompanying editorial.

SOURCE:​

This study was led by Bradley J. Katz, MD, PhD, of the John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah Health, Salt Lake City, Utah. It was published online on January 30, 2025, in JAMA Ophthalmology.

LIMITATIONS:​

This study was limited by the absence of a control group, potential selection bias, and reliance on historical data, which may have resulted in incomplete information and a diminished capacity to establish causality. A risk for confirmation bias existed because the study was initiated after a single case of NAION was found to be associated with semaglutide use.

DISCLOSURES:​

This study was supported by an unrestricted grant from Research to Prevent Blindness to the Department of Ophthalmology and Visual Sciences, the University of Utah, Salt Lake City, Utah, and to the Department of Ophthalmology, the University of West Virginia, Morgantown, West Virginia. Some authors declared receiving consultancy fees, grants, advisory board fees, personal fees, and other ties with several pharmaceutical companies and institutions.

 

[kenny]

@missy thanks for this.
I'll be asking my ophthalmologist about this next week.

 

[missy]

@missy thanks for this.
I'll be asking my ophthalmologist about this next week.

Good luck Kenny. I absolutely wouldn’t stop the med since it’s such a benefit to your health but it is a good idea to discuss with your physician

There’s no definitive causation here. Just the beginning of the research. Correlation only

 

[Sunrises Sunsets]

That's concerning and I appreciate your sharing this information. I know several diabetics who are currently on the ozempic management system and I'll show them this recent discovery.

 

[adlgel]

While not discounting any results from this study, I think the statistic noted about the increase of macular degeneration going from 0.1% to 0.2% in raw numbers seems relatively small. One could accurately say the risk doubled, but it went from 1 in 1000 to 2 in 1000.

 

[Karl_K]

The biggest risk of age-related macular degeneration is genetics.
It runs in my family on my dads side, he and all his siblings all had it and some of my older cousins are developing it.
The study did not eliminate genetics as a factor.
What this study means is there should be a proper study done to see if there is actually an issue.