TOPLINE:

Adults with diabetes and overweight or obesity who started taking tirzepatide had lower 12-month risks for new or worsening diabetic retinopathy, related eye complications, and the need for eye-related treatments or procedures than did those who followed lifestyle intervention alone.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to evaluate whether initiating the incretin drug tirzepatide was associated with the risk of developing or worsening diabetic retinopathy and related eye complications.
• They included adults with type 1 or 2 diabetes with either overweight or obesity diagnosed or a BMI ≥ 27, identified from a large US-based multicenter electronic health record network between January 2022 and June 2025.
• After propensity score matching, the analysis included 86,923 patients prescribed tirzepatide and an equal number of those who received at least one lifestyle intervention alone — such as nutrition or exercise counseling or behavioral advice — with no prior exposure to weight-loss drugs or lifestyle interventions (mean ages, 56.9 and 57.4 years, respectively; 52.3% and 52.6% female, respectively).
• Outcomes were new-onset diabetic retinopathy or progression to more severe stages, related eye complications, and the need for eye-related procedures (intravitreal anti-VEGF injections, panretinal photocoagulation, and pars plana vitrectomy).
• Outcomes were assessed for up to 12 months after the start of treatment, with mean follow-up durations of 273 days and 299 days for those who initiated tirzepatide and lifestyle interventions, respectively.

TAKEAWAY:

• Patients who initiated tirzepatide had a lower 12-month risk for new-onset mild nonproliferative diabetic retinopathy than those who initiated lifestyle intervention alone (risk ratio [RR], 0.864; P = .0290).
• Similar reductions were observed for the risk of developing proliferative diabetic retinopathy (RR, 0.705; P = .0021) and diabetic retinopathy with macular edema (RR, 0.624; P < .0001) among patients taking tirzepatide.
• Patients taking tirzepatide were less likely to experience bleeding into the vitreous cavity (RR, 0.607; P = .0045) and scar tissue pulling the retina away (RR, 0.370; P = .0052).
• The initiation of tirzepatide was associated with a reduced risk of requiring intravitreal anti-VEGF injections (RR, 0.479; P < .0001) and panretinal photocoagulation (RR, 0.610; P = .0183).

IN PRACTICE:

“The present analysis suggests that tirzepatide is unlikely to exacerbate diabetic retinopathy or related complications during the first year of therapy and may confer protection in this population,” the researchers of the study reported. “Prospective studies that incorporate standardized retinal imaging and extend follow-up are needed to confirm the durability of this benefit and to refine recommendations for patients considering weight-loss medications who are at risk for diabetic retinopathy.”

SOURCE:

The study was led by Jaffer Shah, Weill Cornell Medicine, New York City. It was published online on January 21, 2026, in Ophthalmology.

LIMITATIONS:

The follow-up period was limited to 12 months because tirzepatide was newly approved. Retinal outcomes were identified using diagnostic codes rather than imaging. Changes in BMI and A1c levels after initiating the treatments could not be assessed because longitudinal data were unavailable.

DISCLOSURES:

The authors reported having no sources of funding or conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.