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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
PubMed

Insights

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.
Keywords:
GLP-1 receptor agonistsdiabetic retinopathy progressionendothelial dysfunctioninflammationocular adverse eventsretinal microvascular dysfunction

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