GLP-1 receptor agonists and ocular disease: Therapeutic promise, mechanistic insights and emerging safety signals.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed the management of type 2 diabetes and obesity and are increasingly recognised for their pleiotropic effects beyond glycaemic control. Growing evidence suggests that these agents influence inflammatory, vascular and neuroprotective pathways relevant to ocular disease, creating opportunities for therapeutic repurposing while raising important questions regarding long-term ocular safety. This review crucially synthesises current mechanistic, preclinical and clinical evidence regarding the role of GLP-1 RAs across major ophthalmic conditions. Experimental studies consistently demonstrate anti-inflammatory, antioxidative and neurovascular-protective effects, particularly in diabetic retinopathy, whereas clinical studies suggest a potential benefit yet are limited by heterogeneous study designs and the absence of dedicated ophthalmic endpoints. We also examine emerging safety signals, including reported associations with nonarteritic anterior ischaemic optic neuropathy and neovascular age-related macular degeneration, highlighting the limitations of current observational evidence and the uncertainty surrounding causality. Finally, we discuss the translational potential of GLP-1 RAs in immune-mediated ocular diseases such as noninfectious uveitis and identify key priorities for future research. Because the clinical use of GLP-1 RAs continues to expand, carefully designed prospective studies integrating mechanistic insights with standardised ophthalmic outcomes will be essential to define both their therapeutic potential and long-term ocular safety.