You’ll see concerns about eye problems with GLP-1 agonists (semaglutide, etc)...due to recent data.
Most GLP-1 agonist labels already warn about diabetic retinopathy.
Now a new study links GLP-1 agonists to neovascular (or “wet”) age-related macular degeneration (nAMD)...where abnormal blood vessels grow under the retina and leak fluid, which can lead to central vision loss.
Another study suggests that semaglutide may increase the risk of nonarteritic ischemic anterior optic neuropathy (NAION)...or impaired blood flow to the optic nerve, which can lead to sudden loss of vision.
But explain that these findings are based on observational data...and put the risks in perspective, since both conditions are very rare.
For example, about 1 in 1,000 patients aged 66 or older with diabetes who use a GLP-1 agonist for at least 6 months may develop nAMD over 3 years...compared to similar patients not on these medications.
And about 1 additional case of NAION may occur in over 10,000 older patients with diabetes treated with semaglutide over 4 years...compared to non-GLP-1 agonist diabetes meds.
Be aware that the risk of these eye problems seems to go up with longer use. But it’s too soon to say if they’re more likely with certain GLP-1 agonists...or if dose, route, or frequency play a role.
Plus other data show conflicting results...or protective effects.
And diabetes itself is a risk factor for NAION and other eye issues.
Educate that more research is needed in patients using GLP-1 agonists for obesity, obstructive sleep apnea, etc...and to determine why eye problems might occur. One theory is that GLP-1 agonists might reduce blood flow or oxygen levels in eyes if glucose levels decrease quickly.
For now, reassure that the benefits of GLP-1 agonists outweigh any rare ocular risks for most patients.
Recommend a baseline comprehensive eye exam before or within a month of starting a GLP-1...plus a reexamination at least annually.
Counsel patients to watch for warning signs...report any changes in vision right away...and to seek emergency care for vision loss.
For example, vision loss with NAION is often painless and develops in one eye over hours to days. nAMD usually occurs rapidly in one or both eyes...with blurred or distorted areas in the center of vision.
If eye problems occur while on a GLP-1, work with the patient and their providers to weigh risks and benefits and decide whether to stop it.
Check out our new interactive GLP-1 and GIP/GLP-1 Agonists Chart...to create a customizable comparison of available products, dosing, titration, approximate A1c reduction and weight loss, etc.
Stay tuned for our new GLP-1 Agonists CE program for comprehensive guidance on optimizing therapy, patient education, and much more. Look for an announcement soon via email and on PharmacistsLetter.com.
- Shor R, Mihalache A, Noori A, et al. Glucagon-Like Peptide-1 Receptor Agonists and Risk of Neovascular Age-Related Macular Degeneration. JAMA Ophthalmol. 2025 Jul 1;143(7):587-594.
- Hsu AY, Kuo HT, Wang YH, et al. Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy Risk Among Patients With Diabetes. JAMA Ophthalmol. 2025 May 1;143(5):400-407.
- American Academy of Ophthalmology. Should You Stop Taking GLP-1 Drugs Like Ozempic if You Experience Vision Loss? Nation’s Ophthalmologists Respond to European Agency’s New Recommendation. July 7, 2025. https://www.aao.org/newsroom/news-releases/detail/should-you-stop-taking-glp-1-drugs-like-ozempic (Accessed July 23, 2025).