Eye complications and new treatments for diabetes: what do we know today?

Abstract

GLP-1 receptor agonists have transformed the treatment of type 2 diabetes mellitus (T2DM) and obesity, but in recent years questions have arisen regarding their ocular safety, particularly based on signals from observational studies and pharmacovigilance reports.

This dissertation critically reviews the available evidence on the main ophthalmological complications potentially associated with these treatments, including early worsening of diabetic retinopathy, non-arteritic anterior ischemic optic neuropathy (NAION), and age-related macular degeneration. The proposed pathophysiological mechanisms, the strengths and limitations of observational studies and randomized clinical trials will be analyzed, with particular emphasis on evidence of higher methodological standing. The results of the most recent meta-analysis of cardiovascular trials will also be discussed, which does not demonstrate a significant increase in the risk of serious ocular events with the different GLP-1 agonists, although uncertainties remain due to the low frequency of these events. Finally, practical recommendations will be presented for risk assessment, ophthalmological follow-up, and individualized clinical decision-making, with the aim of providing professionals with a balanced and evidence-based view of the ocular safety of new-generation antidiabetic drugs.