A NEW large-scale cohort study suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely prescribed for diabetes and obesity, may significantly increase the risk of neovascular age-related macular degeneration (nAMD) in older adults with diabetes.
Researchers conducted a retrospective population-based study using data from over one million patients with diabetes in Ontario, Canada. Patients aged ≥66 years with at least 1 year of follow-up were included if they had continuous healthcare coverage and medication data. From this group, 139,002 patients were matched in a 1:2 ratio, with 46,334 having been exposed to GLP-1 RAs for at least 6 months and 92,668 serving as unexposed controls. Propensity scores adjusted for socioeconomic status and comorbidities associated with age-related macular degeneration were used to minimise bias.
The incidence of nAMD was significantly higher among those using GLP-1 RAs, with adjusted hazard ratios exceeding 2.0. Specifically, 0.2% of patients in the GLP-1 RA group developed nAMD, compared with 0.1% in the unexposed group. The adjusted hazard ratio for nAMD in the exposed cohort was 2.21 (95% CI: 1.65–2.96), indicating more than double the risk. This association remained robust after adjusting for confounding factors and was consistent across different analytical models. The average age of participants was 66.2 years, and 46.6% were women.
These findings highlight a potential ocular safety signal for GLP-1 RAs that warrants further investigation. While these medications offer substantial metabolic and cardiovascular benefits, clinicians should remain vigilant, particularly when prescribing to older patients at risk of retinal disease.
Reference
Shor R et al. Glucagon-like peptide-1 receptor agonists and risk of neovascular age-related macular degeneration. JAMA Ophthalmol. 2025; DOI: 10.1001/jamaophthalmol.2025.1455.
