Concerns have emerged regarding potential ocular adverse events with glucagon-like peptide 1 receptor agonists (GLP-1 RAs), particularly ischemic optic neuropathy (ION). A meta-analysis published in Diabetes Care evaluated whether GLP-1 RAs were associated with optic nerve or vision-threatening events in patients with type 2 diabetes or cardiometabolic diseases.

The analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance and included 20 randomized controlled trials involving 83,288 participants. Among these participants, 76.4% had type 2 diabetes. The mean follow-up duration across trials was 2.97 years, corresponding to an estimated cumulative exposure of 240,334 patient-years. Eligible trials investigated GLP-1 RAs in populations with type 2 diabetes or cardiometabolic diseases and reported optic nerve or vision-related adverse events.

The primary outcome was a composite of optic nerve and vision-threatening serious adverse events. These included ischemic optic neuropathy, ocular ischemic syndrome, papilledema, blindness, blurred vision, visual impairment, and reduced visual acuity. Pooled analyses showed that GLP-1 RA use was not associated with an increased risk of the primary composite outcome (odds ratio [OR] 1.20; 95% CI 0.73-1.97; I² = 0%). Individual outcomes were also not significantly associated with GLP-1 RA use, including ischemic optic neuropathy (OR 1.50; 95% CI 0.49-4.63) and vision loss or disturbance events (OR 1.08; 95% CI 0.60-1.94).

The analysis noted that most randomized trials reported vision-threatening events as adverse events rather than prespecified outcomes, which represents an important limitation. Overall, the pooled randomized trial evidence showed no increased risk of optic nerve or vision-threatening events with GLP-1RAs.