Among GLP-1 receptor agonists, semaglutide, dulaglutide, liraglutide, and exenatide show similar risks of sight-threatening diabetic retinopathy in routine clinical practice.
Comparable risk across 4 GLP-1 RAsNo significant differences in sight-threatening retinopathy between semaglutide, dulaglutide, liraglutide, and exenatide
What the researchers found
Semaglutide, dulaglutide, liraglutide, and exenatide showed comparable risks of sight-threatening diabetic retinopathy complications in a large target trial emulation study.
Why it matters
Early semaglutide trial data raised concerns about diabetic eye disease risk. This real-world comparison across GLP-1 agents helps reassure clinicians and patients.
How the study worked
Retrospective observational study using target trial emulation framework with US commercial, Medicare Advantage, and Medicare fee-for-service claims data (2014-2022).
What this study cannot tell us
Observational design using claims data — may miss unreported eye events. Target trial emulation reduces but does not eliminate confounding. No comparison to non-GLP-1 treatments.
How to read the evidence
Target trial emulation using large insurance databases — strong observational evidence, though residual confounding possible.
When this study was published
Published in 2026; covers prescribing data through 2022.
The bigger picture
This addresses one of the key safety concerns about GLP-1 receptor agonists and supports their continued use in diabetes management without elevated eye disease risk relative to each other.
Questions still open
- Do newer GLP-1 agents like high-dose semaglutide carry different eye risks than the doses studied here?
- Does the speed of blood sugar reduction with GLP-1 drugs affect retinopathy risk?
Common questions
Do GLP-1 drugs cause eye problems?
Which GLP-1 drug is safest for my eyes?
Read the original research
Risk of Sight-Threatening Diabetic Retinopathy with Glucagon-Like Peptide-1 Receptor Agonist Use in Routine Clinical Practice: Comparative Effectiveness of Semaglutide, Dulaglutide, Liraglutide, and Exenatide.
Ophthalmology. Retina, 10(2), 142-151
Citation
Barkmeier, Andrew J; Deng, Yihong; Swarna, Kavya Sindhu; Herrin, Jeph; Polley, Eric C; Umpierrez, Guillermo E; Galindo, Rodolfo J; Ross, Joseph S; Mickelson, Mindy M; McCoy, Rozalina G. (2026). Risk of Sight-Threatening Diabetic Retinopathy with Glucagon-Like Peptide-1 Receptor Agonist Use in Routine Clinical Practice: Comparative Effectiveness of Semaglutide, Dulaglutide, Liraglutide, and Exenatide.. Ophthalmology. Retina, 10(2), 142-151. https://doi.org/10.1016/j.oret.2025.07.019