AAO 2026: GLP-1RA initiation not linked to anti-VEGF burden in DME

Starting a glucagon-like peptide 1 receptor agonist (GLP-1RA) was not associated with a change in anti–vascular endothelial growth factor (anti-VEGF) treatment frequency, visual acuity, or central subfield thickness in patients with diabetic macular edema (DME), according to an IRIS Registry (Intelligent Research in Sight) analysis presented by Preeti Nagalamadaka, BS, a third-year medical student at Brown University and a research intern at Harvard. Nagalamadaka presented the findings at the American Academy of Ophthalmology (AAO) 2026 Annual Meeting in New Orleans, Louisiana, and discussed them with Ophthalmology Times.¹

The study was prompted by an observation from Nagalamadaka's principal investigator, who noticed she was spacing out anti-VEGF injections in her clinic for patients with DME who had started a GLP-1RA. The team turned to the IRIS Registry to test whether the pattern held in a large database.

What did the study find?

Investigators matched 9,896 GLP-1RA initiators 1:1 with controls on sociodemographics, DME risk factors such as diabetes duration and retinopathy severity, and factors that influence GLP-1RA selection.¹ "We want them to be as similar as possible in every other way," Nagalamadaka said. Over 36 months, anti-VEGF injection trajectories did not differ significantly between groups (P > .05), nor did visual acuity or central subfield thickness (both P > .05).¹ "It's not increasing the need for anti-VEGF treatment, but it's also not lengthening the treatment," she said, describing the neutral association as reassuring.

What do the findings mean for retina specialists?

Interest in GLP-1RAs and eye health dates to the SUSTAIN-6 trial, which suggested possible diabetic retinopathy complications, and many studies have since examined the question. Based on these results, Nagalamadaka said retina specialists can treat the eye "without worrying too much about GLP-1s or consulting endocrinology." She noted several limitations: the registry captures whether patients started a GLP-1RA but not adherence, electronic health record studies rely on billing codes that may be applied inconsistently, and hemoglobin A1c and body mass index data were not available.

References
1. Nagalamadaka P. Association between GLP-1 receptor agonist use and anti-VEGF treatment frequency in DME: an IRIS Registry retrospective cohort study. Presented at: American Academy of Ophthalmology 2026 Annual Meeting; October 12, 2026; New Orleans, LA. Session PA061.