AAOpt 2026: GLP-1RAs and ocular health

Sherrol Reynolds, OD, FAAO, a professor of optometry at Nova Southeastern University, described her presentation at the 2026 American Academy of Optometry meeting on GLP-1 receptor agonists and ocular health. She also reviewed the American Optometric Association’s 2025 clinical guidance for optometric practice. Reynolds’s central message was that use of these medications is growing rapidly, so eye care practitioners should ask patients about them, educate them about potential eye-related risks, monitor for changes, and coordinate care with the rest of the patient’s healthcare team.

Reynolds said that more than 40 million people in the United States—about one in eight—are using GLP-1 medications. Their use now extends beyond diabetes and weight loss to areas such as sleep apnea, cardiovascular risk, kidney and liver conditions. Researchers are also investigating possible uses for ocular conditions, including idiopathic intracranial hypertension. She noted that the scale of use may be underestimated because some people obtain medications online without a prescription or do not disclose their use.

The presentation focused on 2 reported ocular concerns. First, a rapid decline in A1C while taking these medications may be associated with worsening diabetic retinopathy and an earlier need for treatment. Second, non-arteritic ischemic optic neuropathy has been reported, although the risk is considered low. Reynolds emphasized that low risk does not mean practitioners should disregard the possibility. A 5-year focused trial is expected to provide more information, with results anticipated in 2027.

For patient management, Reynolds recommended considering a baseline eye examination, potentially including color photographs and OCT. Patients who already have retinopathy may need closer or earlier follow-up, particularly if their diabetes is poorly controlled, their A1C is high, they use insulin, or the clinician sees rapid changes in the fundus. Other factors that may warrant attention include hypertension, hypercholesterolemia, and a small, crowded optic nerve head. Reynolds also highlighted that some populations face disproportionate risks related to diabetes and associated conditions.

She stressed the importance of urgent action if a patient experiences sudden, painless vision loss: the patient should contact an eye care practitioner and seek emergency evaluation. Reynolds shared a case in which a patient’s retinopathy worsened after starting oral semaglutide, illustrating why monitoring matters. She concluded that eye care providers are part of the broader diabetes and healthcare team, and should communicate with the patient’s other clinicians when retinal changes or complications arise.