Can I take GLP-1 medications if I have diabetic retinopathy?

GLP-1 medications require caution in patients with diabetic retinopathy. Early trials suggested possible worsening of retinopathy with rapid glucose improvements (called 'early worsening phenomenon'), similar to what occurs with intensive insulin therapy. However, longer-term data shows neutral or beneficial effects on retinopathy progression. The SUSTAIN-6 trial initially raised concerns, but the overall evidence suggests GLP-1s don't increase long-term retinopathy risk. For patients with active proliferative retinopathy or recent laser treatment, providers may delay GLP-1 initiation until retinopathy is stable. Patients with non-proliferative retinopathy can generally start GLP-1s with standard monitoring. The cardiovascular and kidney benefits of GLP-1s often outweigh retinopathy concerns for most patients. All diabetic patients on GLP-1s should have annual dilated eye exams or more frequently if retinopathy is present.