The Role of GLP-1 Receptor Agonists in Age-Related Macular Degeneration: Insights from a Cohort Study

GLP-1 receptor agonists were associated with a lower incidence of nonexudative age-related macular degeneration in a recent cohort study. The finding arrives as GLP-1 RA use expands rapidly for weight loss and diabetes; clinicians will need to consider potential ocular outcomes alongside the clear metabolic benefits.

The investigators used a large new‑user observational cohort of 91,408 patients aged 55 years or older with overweight or obesity, excluding those with preexisting AMD in the primary analysis. They compared initiators of GLP-1 RAs with patients prescribed other weight‑loss agents as an active comparator, followed matched cohorts for up to 10 years, and prespecified incident nonexudative AMD and progression to exudative (neovascular) AMD as primary endpoints. Across multiple time horizons, the principal result was a significantly lower incidence of nonexudative AMD among GLP-1 RA initiators versus the comparator group.

Propensity-score matching balanced baseline demographics, comorbidities, and measured ocular risk factors. Multivariable-adjusted time-to-event hazard models estimated incident risks while accounting for censoring and variable follow-up. The team ran sensitivity analyses and subgroup checks—alternate exposure definitions, restricted cohorts, and variation in adjustment sets—to probe robustness and identify influential subgroups. These methods strengthen causal inference by reducing measured confounding, although residual confounding and unmeasured bias cannot be excluded.

No association emerged between GLP-1 RA exposure and progression to exudative (neovascular) AMD within the study’s follow-up window. In other words, the reduced incidence of new nonexudative disease did not translate into a measurable decrease in conversion to sight‑threatening neovascular AMD during the observation period. Possible explanations include differential case detection, limited event rates or follow-up time for conversion, and biologic heterogeneity; clarifying progression will require prospective study designs with standardized ocular surveillance.

The data suggest a potential protective association for incident nonexudative AMD while showing no observed effect on neovascular progression—findings that remain bounded by the limits of observational analysis.

Key Takeaways:

• GLP-1 RA use was associated with a lower incidence of nonexudative AMD in a large, matched new‑user cohort.
• No association was found between GLP-1 RA use and progression to exudative (neovascular) AMD within the observed follow-up.
• Robust analytic methods were applied, but residual confounding and follow-up constraints limit causal inference; prospective studies with ocular endpoints are warranted.