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GLP-1 RAs May Reduce Risk of Retinal Vein Occlusion, with Aleksandra Rachitskaya, MD, and Kevin Allan, MD, PhD
Results from a recent trial indicated continuously decreasing risks of all forms of retinal vascular occlusion and retinal vein occlusion for 5 years after treatment.
According to a recent study, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may potentially reduce the risk of retinal vascular occlusions: this protective effect may be mediated by risk factor reduction and anti-inflammatory properties.1
Presented at the 43rd Annual Scientific Meeting of the American Society of Retina Specialists in Long Beach, CA, this study was formatted around an electronic health record platform including >120 million patients in the US. Investigators then followed up with patients at 1, 3, and 5 years.1
The recent popularity of GLP-1 RAs, such as semaglutide, in both the prescription and over-the-counter markets has led to a transformation in several medical specialties. However, clinicians have also warned of potential negative side effects in areas outside of endocrinology.
Despite this, literature has supported both sides of the argument. For instance, a recent paper investigating the connection between GLP-1 RAs and nonarteritic anterior ischemic optic neuropathy (NAION) found no significant increase in risk. Similarly, GLP-1 RAs were found last year to have minimal association with diabetic retinopathy progression.2,3
HCPLive sat down with presenting investigators Aleksandra Rachitskaya, MD, FASRS, and Kevin Allan, MD, PhD, from the Cleveland Clinic Cole Eye Institute, to discuss their findings and the implications of these results.
“We looked at total vascular occlusions, a combination of the artery occlusions and the RD occlusions, and we saw a significant reduction in total vascular occlusions at every time point, 1 to 5 years,” Allan told HCPLive. “When we looked at the vein occlusions, we saw earlier effects at 1 and 3 years. There was a significant reduction with the GLP-1 receptor agonist usage.”
To be included, patients had to be ≥18 years old with a GLP-1 RA prescription and ophthalmology follow-up for 1, 3, and 5 years. A control cohort was also formed, including patients with a non-GLP-1 RA prescription, an insulin prescription, and ophthalmology follow-up.1
A total of 53,413 patients after 1 year, 25,738 after 3 years, and 14,695 after 5 years of taking GLP-1 RAs were compared to an equal number of controls. Patients were propensity score matched in a 1:1 ratio on demographics and chronic disease risk factors. Average age was 57.9 +/- 11.8, and 58% of the GLP-1 RA group were female. Average BMI was 35.6 +/- 7.9 (mean HbA1c 8.2 +/- 2).1
After 3 years of study, investigators noted a significant reduction in the hazard of all retinal vascular occlusions (HR .71; 95% CI, .59-.86), all RVOs (HR .75; 95% CI, .59-.94), all RAOs (HR .55; 95% CI, .39-.78), as well as branch RVOs and branch RAOs. Notably, central RAOs demonstrated a not statistically significant risk reduction. Investigators compared outcomes at 1 and 5 years, indicating consistently decreasing hazard trends of all outcomes at all timepoints.1
Rachitskaya spoke on next steps for the investigation of GLP-1 RAs in ophthalmology, noting the limited literature connecting the medication to ocular health.
“When these drugs were developed, nobody was thinking about the eye,” Rachitskaya said. “You have to go back and study these effects to elucidate exactly what the contribution of these medications is. I see these large database studies as a stepping stone, right? We see this trend; we need to now go back to more granular analysis.”
Editor’s Note: Rachitskaya reports disclosures with DRCR Retina Network, Samsara, Boehringer Ingelheim, Beacon Therapeutics, Alcon, Genentech, and others. Allan reports no relevant disclosures.
References
Rachitskaya A, Abbass N, Kaebler D, et al. The Impact of Glucagon-Like Peptide-1 Receptor Agonists on the Risk of Retinal Vein and Artery Occlusions. Abstract presented at the 43rd Annual Scientific Meeting of the American Society of Retina Specialists in Long Beach, CA, July 30-August 2, 2025.
Abbass NJ, Nahlawi R, Shaia JK, et al. The Effect of Semaglutide and GLP-1 RAs on Risk of Nonarteritic Anterior Ischemic Optic Neuropathy. Am J Ophthalmol. 2025;274:24-31. doi:10.1016/j.ajo.2025.02.025
Michaeli T, Khateb S, Levy J. The Effect of Glucagon-like-Peptide-1 Receptor Agonists on Diabetic Retinopathy Progression, Central Subfield Thickness, and Response to Intravitreal Injections. J Clin Med. 2024;13(20):6269. Published 2024 Oct 21. doi:10.3390/jcm13206269
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