Ozempic, a GLP-1 receptor agonist with the active ingredient known as semaglutide, has been hailed as a wonder drug in diabetes and weight management treatment. The drug is rising in popularity at clinical practices and has proven benefits relating to blood sugar levels, cardiovascular protection, renal care, and most notably, weight management.
However, there have been noted safety concerns linked to Ozempic, especially due to the eye-related risks associated with continued use of the drug, including diabetic retinopathy and other retinal complications.
Previous studies, while inconclusive, have raised concerns that the use of GLP-1 drugs lead to a higher rate of early worsening of DR, especially in patients with pre-existing retinopathy or those who experience rapid blood sugar improvement. This can be considered to be a knock-on effect of the drug, rather than a direct side-effect. Other retinal events, such as macular oedema, retinal haemorrhage, and retinal detachment, have also been reported, but they are fewer in number.
While the results of GLP-1 medications and their on-brand usage are generally positive, the rapid improvements in blood sugar levels should remain a concern for ophthalmologists. These changes in sugar levels contribute to transient retinal changes in patients who have pre-existing DR, and lead to further questions on what other complications can come about with prolonged usage.
Rare complications
According to the European Medicines Agency (EMA), a vision-threatening condition like Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) is estimated to affect 1 in 10,000 GLP-1 users.
In June 2025, the EMA’s safety division, the Pharmacovigilance Risk Assessment Committee (PRAC), concluded a review of GLP-1 medication and its risk of patients developing NAION. After studying data from non-clinical studies, clinical trials, post-marketing surveillance, and medical literature, the committee found that NAION is a very rare side effect of GLP-1. They recommended that the drug’s product information should be included to reflect this potential risk to patients.
Screening and monitoring
Recommendations for patients starting or currently on GLP-1 medication would be to have a baseline dilated fundoscopy, followed by annual retinal exams to monitor any irregularities in patients. This will aid in early detection and prompt treatment for patients presenting any concerning signs of deteriorating eye function.
NAION is not the only concern ophthalmologists have pertaining to GLP-1 use and its effect on eye function. Other potential issues include macula oedema, retinal haemorrhaging due to the worsening of DR, and neovascular (wet) age-related macular degeneration (nAMD), which was reported by JAMA as having a 2-fold higher risk of development due to prolonged of GLP-1 therapy.
However, reports for these eye concerns are currently fewer in number, and no clear causal link has been established. This does not mean, of course, that there is no need for caution, and clinical research is continuing to investigate these potential effects of GLP-1 use.
Future research
Because causal links between GLP-1 and eye concerns have not yet been established, regulatory agencies and researchers are actively monitoring ocular safety and conducting clinical trials to provide conclusive evidence. Upcoming studies are expected to clarify the mechanisms and long-term impact of GLP-1 drugs on eye health.
Despite its evident benefits in diabetes and weight loss treatments, GLP-1 use remains a significant concern for ophthalmologists. And while the aforementioned JAMA and EMA reviews have provided stepping stones to better understanding the risks involved with the drug, further research continues to investigate the causal links between GLP-1 and NAION and nAMD development.
