GLP-1 Receptor Agonists: What Eye Care Professionals Need to Know About Emerging Vision Risks

Glucagon-like peptide-1 receptor agonists, commonly referred to as GLP-1s, are among the most significant new advancements in medicine. About 1 in 8 Americans has taken a GLP-1 at some point, and today, about 6% of all adults are using this medication to treat type 2 diabetes and obesity. This number is rising as more and more patients are being prescribed GLP-1s for their great benefits. However, far fewer are aware of their rare but serious side effects that may impact vision.

Why GLP-1s Are Suddenly on Every Patient’s Medication List

To understand the sudden increase in prescriptions for GLP-1s, it is essential to understand their purpose and function. This drug class helps regulate blood sugar by increasing insulin, suppressing the release of glucagon, and reducing appetite. Along with managing type 2 diabetes and other systemic diseases, this can lead to fast and profound weight loss. GLP-1s are highly effective and can have additional positive side effects, including a reduction in ocular pathology. For this reason, it is important for patient-eye doctor discussions regarding their overall health, diabetes status, weight-loss efforts, and long-term goals.

The most common GLP-1s for diabetes and weight loss are:

• Semaglutide (Ozempic and Wegovy, both by Novo Nordisk)
• Tirzepatide (Mounjaro and Zepbound, both by Eli Lilly)
• Dulaglutide (Trulicity by Eli Lilly)

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There’s a good chance you’ll encounter patients taking GLP-1s in your practice, and rarely, they may show signs of vision problems. When conducting screenings and establishing baselines for common chronic conditions, eye doctors need to be aware of specific but rare side effects that may be related to certain weight loss medications.

Snapshot of Newly Reported Ocular Adverse Events

Through observation and patient reports, eye care professionals have noticed the following trends:

1.     Diabetic Retinopathy (DR) Progression and Complications

GLP-1s are used for diabetic patients, and although one might intuitively conclude that means improvement of diabetic retinopathy, it may not always be the case. The SUSTAIN-6 trial found that GLP-1 DR progression may be related to rapid blood sugar changes and an increase in the progression of DR

2.     Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)

Poor blood flow and swelling around the optic nerve may lead to NAION. Semaglutide optic neuropathy is a possibility, although the European Medicines Agency (EMA) concluded that it’s very rare. Eye doctors need to know that a “disc-at-risk” places the patient using GLP-1s at an elevated risk for NAION. Still, if patients experience worsening or sudden changes in vision, there may be a link to GLP-1 use, and they may need to discontinue the drug immediately. If you are taking a GLP-1 and experience any level of vision loss, see your eye doctor immediately.

3.     Papillitis and Paracentral Acute Middle Maculopathy (PAMM)

In a recent study of patients experiencing GLP-1 eye side effects, one patient had papillitis. This optic nerve head inflammation can cause blurred vision, visual field defects, blind spots, and ultimately, permanent loss of vision.

4.     Possible Neuro-Protective Benefit for Glaucoma

Not all side effects are adverse. New research suggests there might be a statistically significant decrease in glaucoma among people who take GLP-1s long-term. Glaucoma impacts millions of Americans and can lead to permanent blindness, so this could be a promising new angle.

Potential Cause and Effect Factors

Several factors may contribute to vision-related side effects associated with these Glucagon-like peptide-1 receptor agonists.

Glycemic and Vascular Shifts

When patients begin GLP-1 therapy, the rapid reduction in blood glucose can create osmotic shifts that place stress on the optic nerve and retinal microvasculature. At the same time, underlying comorbidities like hypertension and diabetes may contribute to vascular dysregulation and endothelial changes. Together, these shifts can alter blood flow to the retina and optic nerve, increasing the risk of edema, microvascular strain, and other vision-related complications during the early phases of treatment.

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Neurochemical Receptor Disruption in the Retina and Optic Nerve

GLP-1 receptors are also present in the retina and the optic nerve, not just in the gut, which might explain why certain eye conditions appear in patients taking this drug class.

Who's at Greatest Risk of Weight-Loss Drug Eye Complications?

For many patients, weight loss medications are safe and are unlikely to cause ocular or vision problems. There are, however, a few populations that might be at higher risk:

1. Long‑standing diabetics with moderate/severe NPDR or prior pan‑retinal photocoagulation. This group is already at risk for diabetic retinopathy complications.
2. Patients with very high baseline HbA1c (>9 %) or rapid HbA1c drop (>1.5 % in 3 months). Sudden glycemic changes could stress retinal and optic nerve structures.
3. Females who have been on Ozempic for at least two  years. Reuters reported on an Ozempic vision loss study that found an elevated risk of NAION among women taking semaglutide, specifically.
4. People with optic‑disc “crowding” (small cup‑to‑disc, aka a “disc-at-risk”), sleep apnea, or other NAION risk factors. People with these anatomical and related risk factors may have worsened ischemic optic neuropathy.

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Policy Shift: Medicare & Medicaid May Cover GLP‑1s for Weight Loss

Until now, Medicare Part D has only covered GLP‑1 receptor agonists for diabetes or cardiovascular indications, and Medicaid coverage for obesity use has remained limited to just a few states. But groundbreaking policy changes are on the horizon. A new five‑year pilot program, proposed by the Center for Medicare & Medicaid Innovation (CMMI), would allow state Medicaid plans starting in April 2026, and voluntary Medicare Part D plans starting in January 2027, to offer coverage for GLP‑1 medications such as Ozempic, Wegovy, Mounjaro, and Zepbound when prescribed for weight management This marks a major policy shift from earlier 2025 decisions, during which CMS under previous leadership formally dropped a a proposal to mandate obesity coverage under Medicare and Medicaid. The proposed pilot, though voluntary for insurers, signals a warming attitude toward treating obesity as a chronic disease requiring medical intervention.

If the program expands widely, millions of seniors and low-income adults may gain access to GLP‑1 medications for weight management through government plans. In 2024, the then-HHS Secretary Xavier Becerra characterized the proposed expansion of GLP‑1 coverage as "a game changer" in addressing obesity’s impact on health and the economy. However, there are concerns about cost sustainability. In April 2025, it was reported that the Congressional Budget Office (CBO) estimated that expanding Medicare coverage of GLP‑1 drugs for obesity would add approximately $35 billion in federal spending from 2026 to 2034.

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Practical Preventive and Treatment Plan Protocol for Eye Care Providers

If you have a patient who’s planning to take GLP-1 medications, you can take steps to minimize their risk of ocular complications.

Before GLP-1 Initiation

The American Optometric Association (AOA) recommends that all patients taking GLP-1s, especially those with diabetes or any form of age-related macular degeneration, undergo a comprehensive eye exam to establish a baseline. This exam should include a dilated fundus exam, fundus photography, and OCT imaging. This will help you measure any changes that could be related to their medication use.

Be sure to inform the patient’s primary care provider or endocrinologist of their ocular status, especially if they have any signs of diabetic retinopathy.

During the First 12 Months

Progressive diabetic retinopathy and GLP-1 use could be associated in rare cases.. For patients with any degree of DR, follow up every 3 to 6 months. If there are no signs of DR, schedule an annual exam (or sooner if necessary) with documentation of any subjective changes in vision or retinal status.

Whenever possible, encourage a gradual titration of GLP-1 doses to minimize rapid fluctuations in blood sugar levels.

After 12 Months

For patients on GLP-1s for longer than 2 years, implement a checklist to screen for symptoms of NAION. Watch for sudden, painless vision loss or altitudinal visual defects. NAION can cause permanent vision loss, so maintain a low threshold for urgent referral to a neuro-ophthalmologist if signs of optic neuropathy are suspected.

If diabetic retinopathy worsens, consider a referral to a retinal specialist for possible anti-VEGF therapy or pan-retinal photocoagulation (PRP) as per standard DR guidelines. Always coordinate with the patient’s systemic care team before discontinuing medication.

Throughout care, provide clear patient education. There may be potential vision complications, but the benefits of treatments often outweigh the risks. Throughout patients’ weight loss and diabetes journeys, you can monitor their eye health to support their overall wellness.

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What Eye Doctors Should Know About GLP-1s and Anesthesia Risks

While ocular complications are increasingly recognized, another emerging concern around GLP-1 medications has gained attention in surgical settings: delayed gastric emptying and its potential impact on anesthesia. GLP-1 receptor agonists are known to slow gastrointestinal motility, raising the risk of regurgitation or aspiration during procedures requiring general anesthesia or deep sedation.

New guidance from the American Society of Anesthesiologists (ASA) and other perioperative associations now recommends withholding weekly GLP-1s for up to 7 days before surgery, or even up to 14 days in certain high-risk procedures like joint replacement. Patients on daily GLP-1s are typically advised to skip their dose on the day of surgery. For individuals with significant GI symptoms, elective procedures may need to be postponed, while asymptomatic patients may proceed under “full stomach” precautions or after a preoperative gastric ultrasound.

Although these anesthesia-related issues may not arise in routine eye care, they are critical for optometrists and ophthalmologists who co-manage surgical patients or refer for cataract extraction, glaucoma surgery, or retinal procedures. If your patient is scheduled for surgery, especially one requiring sedation, it’s important to encourage them to notify the surgical team of their GLP-1 use and follow the appropriate holding protocol. Coordination with the patient’s primary care provider or endocrinologist is advised to ensure safe perioperative glucose management. This is another example of why medication reconciliation and interdisciplinary communication are essential parts of the comprehensive care you provide.

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Final Thoughts: Coordinate Care With Prescribing Physicians

Weight loss drug eye complications are rare. For most eligible patients, these drugs are safe, and for some, they’re life-changing. At the same time, the GLP-1 vision risks should not be overlooked. You have a role in GLP-1 ocular safety, and by working closely with patients’ prescribing physicians, you can help them lose weight and manage diabetes safely.

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