Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA) widely prescribed for type 2 diabetes and obesity, is not associated with an increased risk of diabetic retinopathy or overall eye disorders, according to results of a large-scale systematic review and meta-analysis published in JAMA Ophthalmology.

While semaglutide’s cardiovascular benefits and metabolic effects are well established, concerns have lingered regarding its potential role in ocular complications such as retinopathy progression or nonarteritic anterior ischemic optic neuropathy (NAION).

Trial sequence analysis confirmed the evidence base is sufficient to exclude a major risk signal for diabetic retinopathy but remains underpowered to draw firm conclusions about NAION.

Results for diabetic retinopathy did not differ by comparator type or duration of follow-up (≤1 year vs >1 year). No subgroup analysis was possible for NAION due to the small number of events.

The analysis was limited by the lack of standardized ophthalmologic assessments, variability in diagnostic methods, and the exclusion of high-risk patients across trials.

The authors concluded: “Treatment with semaglutide in adults was not associated with an increased risk of eye disorders or diabetic retinopathy in this study, and future studies are unlikely to change these results. However, treatment with semaglutide was associated with the occurrence of NAION, despite the fact that no definitive conclusions regarding this association could be drawn.”

For most patients, semaglutide does not appear to raise the risk of diabetic retinopathy or other ocular complications. Clinicians may wish to remain cautious regarding NAION until further evidence clarifies this rare but serious potential risk.