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The Effects of GLP-1 Receptor Agonists on Retinal Microvascular Alterations
Stamatios Lampsas1, Gerasimia-Marina Chardalia1, Chrysa Agapitou1
1Second Department of Ophthalmology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 12462 Athens, Greece.
Biomedicines
|May 27, 2026
Summary
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer retinal microvascular protection in type 2 diabetes. However, emerging data suggest potential, though inconclusive, retinal adverse events, necessitating further research.
Area of Science:
- Ophthalmology
- Endocrinology
- Pharmacology
Background:
- Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are vital for type 2 diabetes mellitus (T2DM) management, offering glycemic, cardiac, and renal benefits.
- GLP-1RAs demonstrate pleiotropic effects on retinal microvasculature, including improved endothelial function and reduced oxidative stress.
Purpose of the Study:
- To review mechanistic, preclinical, and clinical evidence on GLP-1RA impact on retinal microvasculature.
- To summarize current clinical evidence regarding GLP-1RA-associated retinal complications.
Main Methods:
- Systematic review of mechanistic studies.
- Analysis of preclinical data.
- Evaluation of clinical evidence, including observational studies and pharmacovigilance data.
Main Results:
- GLP-1RAs protect retinal microvasculature by improving endothelial function, reducing oxidative stress, inflammation, and preserving the blood-retinal barrier.
- Emerging clinical data suggest potential associations between GLP-1RA use and retinal adverse events like non-arteritic anterior ischemic optic neuropathy (NAION) and diabetic macular edema (DME).
- Evidence for these retinal complications is largely from retrospective studies, limiting causal inference.
Conclusions:
- While GLP-1RAs show promise for retinal microvascular protection, potential adverse events require careful consideration.
- Current evidence on GLP-1RA-induced retinal complications is heterogeneous and inconclusive.
- Large, randomized trials with standardized ocular endpoints are needed to clarify GLP-1RA retinal safety.
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