Mayuri Deka, Assistant Professor,
Department of Optometry, School of Allied Health Sciences, The Assam Kaziranga University, Jorhat, India
Keywords
GLP-1 receptor agonists, semaglutide, diabetic retinopathy, retinal neovascularisation, optometry, screening.
Declaration of Interest
The author declares no conflicts of interest related to this article.
Patient Vignette Note
The opening patient vignette is a composite, anonymised clinical scenario intended for educational purposes; it does not identify a real patient.
A patient comes in for what looks like a routine exam. Almost as an aside, she mentions she started semaglutide six months ago and is down eighteen pounds. She looks great, her A1c has finally come under control, and by every conventional measure she is a success story. Then the dilated view tells a different story: new vessels growing where none existed before.
This scenario is turning up in Optometry practices more often than most of us anticipated, and it deserves more than a passing mention in a Diabetes update.
GLP-1 receptor agonists like semaglutide are arguably the defining pharmaceutical story of the decade, prescribed at an accelerating pace for both type 2 Diabetes and weight management. What gets far less attention outside retina-focused circles is that the very metabolic improvement patients are celebrating can, in a subset of them, speed up Diabetic Retinopathy in the short term. Researchers from the Southern College of Optometry and a Veteran Affairs (VA) medical centre recently presented a case in which proliferative retinopathy progressed so quickly after semaglutide initiation that the patient needed bilateral anti-VEGF injections within a matter of months (Grimes, 2026). That finding is not coming out of nowhere, it echoes a signal first flagged years earlier in the SUSTAIN-6 cardiovascular outcomes trial, which found retinopathy complications occurring more frequently in the semaglutide arm, clustered almost entirely among patients who already had pre-existing retinal disease (Vilsbøll et al., 2018).
The underlying mechanism does not appear to involve any direct toxicity to the eye. It is really a story about speed. When blood sugar falls quickly after a long period of poor control, the retina can respond paradoxically, worsening briefly before it settles down, a pattern that is well established in the broader glycemic-control literature and is now being re-examined specifically in the context of GLP-1 therapy (Akil et al., 2022). A retrospective analysis of nearly four thousand patients found that this risk was far from random: it tracked closely with baseline disease severity, with patients starting from mild retinopathy facing a low chance of progression, while those who already had proliferative changes faced a much steeper climb (ScienceDirect, 2024). To complicate matters further, at least one case report described the reverse, semaglutide appearing to help resolve proliferative changes in a different patient altogether (Cool et al., 2024).
What does this mean at the chair side? It means a GLP-1 prescription on a patient’s intake form is no longer background noise; it is a signal. A patient who is starting or has recently escalated this therapy, particularly one with a history of poor glycemic control or existing retinopathy, warrants closer monitoring in the months right after initiation, not just a slot on the next annual exam. Optometrists are often the first clinicians to examine the retina after a primary care provider hands over that prescription, which puts us in a position of real importance, whether we have fully registered that yet or not.
The weight-loss drug era shows no sign of slowing down. Our screening intervals need to catch up with it.
References
- Akil, H., Burgess, J., & Nevitt, S. (2022). Early worsening of retinopathy in type 1 and type 2 diabetes after rapid improvement in glycaemic control: A systematic review. Diabetes Therapy, 13(1), 1–23.
- Cool, D., Coventon, J., & Sharma, A. (2024). Semaglutide inducing resolution of proliferative diabetic retinopathy: A case report. Case Reports in Ophthalmology. https://doi.org/10.1155/crop/5834769
- Grimes, H. E. (2026, June 17–20). Semaglutide initiation and rapid diabetic retinopathy progression: A case report [Poster presentation]. American Optometric Association Optometry’s Meeting, Phoenix, AZ, United States.
- Long-term use of semaglutide and risk of diabetic retinopathy progression. (2024). ScienceDirect. https://www.sciencedirect.com/science/article/pii/S2666396124000128
- Vilsboll, T., Bain, S. C., Leiter, L. A., Lingvay, I., Matthews, D., Simó, R., Helmark, I. C., Wijayasinghe, N., & Larsen, M. (2018). Semaglutide, reduction in glycated haemoglobin and the risk of diabetic retinopathy. Diabetes, Obesity and Metabolism, 20(4), 889–897.
About the Author
Mayuri Deka
Assistant Professor,