GlidedoseGLP-1s and diabetic retinopathy: what the labels say
Short answer: six of the eight US labels covered here (Ozempic, Rybelsus, Wegovy, Trulicity, Mounjaro and Zepbound) warn that diabetic retinopathy can temporarily worsen when blood sugar improves quickly, and say people with a history of retinopathy should be monitored. In the trials they quote, the extra risk was concentrated in people who already had retinopathy: for Ozempic, 8.2% vs 5.2% on placebo, compared with 0.7% vs 0.4% in people without a known history. Saxenda and Victoza have no such warning, and the Canadian Trulicity monograph doesn't either.
On this page: US label rates · Canadian monographs · Why it happens · NAION is different · What to log
US labels: the retinopathy warning, drug by drug
Each figure below is from section 5 (Warnings and Precautions) of the current US prescribing information on DailyMed, checked November 4, 2026. "History" means people who had diabetic retinopathy when the trial started. The trials differ in length and population, so compare each drug with its own placebo, not across rows.
| Medication | US section | Overall rate | With a history of retinopathy | Without a known history |
|---|---|---|---|---|
| Ozempic (semaglutide injection) | 5.3 | SUSTAIN 6, 2 years: 3.0% vs 1.8% placebo | 8.2% vs 5.2% | 0.7% vs 0.4% |
| Rybelsus / Ozempic tablets | 5.3 | Pooled glycemic trials: 4.2% vs 3.8% comparator; also quotes SUSTAIN 6 | 8.2% vs 5.2% (SUSTAIN 6) | 0.7% vs 0.4% (SUSTAIN 6) |
| Wegovy (semaglutide) | 5.8 (type 2 diabetes) | SUSTAIN 6: 3% vs 1.8%; weight trial in type 2 diabetes: 4% vs 2.7% | 8.2% vs 5.2% (SUSTAIN 6) | 0.7% vs 0.4% (SUSTAIN 6) |
| Trulicity (dulaglutide) | 5.7 | REWIND, median 5.4 years: 1.9% (1.5 mg) vs 1.5% placebo | 8.5% vs 6.2% | 1% vs 1% |
| Mounjaro (tirzepatide) | 5.7 | No trial rate given | Not given | Not given |
| Zepbound (tirzepatide) | 5.8 (type 2 diabetes) | No trial rate given | Not given | Not given |
| Saxenda (liraglutide) | None | No retinopathy warning | ||
| Victoza (liraglutide) | None | No retinopathy warning |
Two more details from the US labels:
- Wegovy tablets: in a glycemic control trial in type 2 diabetes of semaglutide tablet doses comparable to 9 mg and 25 mg, 1.3% and 1.9% of patients reported moderate to severe non-proliferative retinopathy, and 0% and 0.4% reported proliferative retinopathy.
- Ozempic, Rybelsus and Wegovy all say the effect of long-term glycemic control with semaglutide on diabetic retinopathy complications has not been studied. Zepbound's warning, like Wegovy's, is limited to patients with type 2 diabetes, and the Zepbound label tells those patients to contact their provider if their vision changes.
Canada: what the product monographs add
The Health Canada product monographs put the warning under "Ophthalmologic" in section 7. They mostly match the US text, with a few differences worth knowing.
| Monograph | Retinopathy warning | Rates reported | Extra wording | Monograph date |
|---|---|---|---|---|
| Ozempic | Yes (Ophthalmologic) | SUSTAIN 6 (3,297 patients): 3.0% vs 1.8%; over 80% of events were in people with a documented history; trials up to 1 year (4,807 patients): 1.7% vs 2.0% comparators | Long-term glycemic control "may decrease" retinopathy risk | 2026-07-13 |
| Rybelsus | Yes (Ophthalmologic) | Pooled: 4.2% vs 3.8%; placebo-controlled table: 3.7% (7 mg), 2.8% (14 mg), 2.8% placebo | Monitor for worsening and treat according to clinical guidelines | 2026-07-13 |
| Wegovy | Yes (retinal disorders, type 2 diabetes) | Retinal disorders 6.9% Wegovy, 6.2% semaglutide 1 mg, 4.2% placebo; diabetic retinopathy 4.0%, 2.7%, 2.7% | Too few teens with type 2 diabetes to assess | 2025-12-10 |
| Mounjaro | Yes (Ophthalmologic) | No rate given | Not studied in NPDR needing acute therapy, PDR or macular edema; use with caution | 2026-06-23 |
| Zepbound | Yes (type 2 diabetes) | No rate given | Same not-studied list as Mounjaro | 2026-06-11 |
| Trulicity | No | Not in the monograph checked | US label has a warning; Canadian monograph does not | 2024-07-05 (revision) |
| Victoza | No | Listed only in trial adverse-event tables | 2022-12-09 (revision) | |
| Saxenda | No | Not mentioned | 2022-12-09 (revision) |
- What the Ozempic endpoint means: the Canadian Ozempic monograph spells out the SUSTAIN 6 composite: need for retinal laser (photocoagulation), need for eye injections (intravitreal agents), vitreous hemorrhage, and diabetes-related blindness. In people without a documented history, the number of events was similar on Ozempic and placebo.
- Long-term control: the US semaglutide labels say the long-term effect "has not been studied", while the Canadian Ozempic monograph says long-term glycemic control "may decrease" the risk of retinopathy and the Rybelsus monograph says it "decreases" it.
- Tirzepatide caution: only the Canadian Mounjaro and Zepbound monographs say the drug has not been studied in non-proliferative retinopathy requiring acute therapy, proliferative retinopathy or diabetic macular edema, and should be used with caution in these patients with appropriate monitoring.
- Trulicity: the US label has a full warning with REWIND numbers; the Canadian monograph we checked (revised July 5, 2024) has none.
The reason the labels give
All six warnings use the same sentence: rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy. The labels do not say the drug damages the retina directly. The Mounjaro patient information in Canada puts it plainly: fast improvements in blood sugar may lead to a temporary worsening of diabetic eye disease, which may require treatment or lead to a loss of vision. None of the labels set a specific eye exam schedule; they say people with a history of retinopathy should be monitored for progression.
NAION is a separate warning
NAION (non-arteritic anterior ischemic optic neuropathy) affects the optic nerve rather than the retina. The Canadian Ozempic, Rybelsus, Mounjaro and Zepbound monographs say patients reporting a sudden loss of vision, including partial loss, should be urgently referred for an eye exam and the drug discontinued if NAION is confirmed. The semaglutide monographs describe the risk as very rare, based on epidemiological studies. More detail is in our thyroid warning and contraindications guide.
What to log and tell your prescriber
- Whether you have diabetic retinopathy or macular edema, and the date of your last eye exam, before you start.
- Vision changes: the date, which eye, and what changed (blurring, floaters, dark areas, partial loss).
- Your dose changes and blood sugar or A1C results, since the labels tie the warning to how fast glucose improves.
- Any eye treatment you receive, such as laser or injections.
Sudden loss of vision, even in part of one eye, is a reason to get urgent care right away.
For the other class warnings, see GLP-1 pancreatitis and gallbladder warnings and GLP-1 side effects: rates and tracking.
Sources
- Ozempic prescribing information, section 5.3 (DailyMed, US)
- Rybelsus and Ozempic tablets prescribing information, sections 5.3 and 6 (DailyMed, US)
- Wegovy prescribing information, section 5.8 (DailyMed, US)
- Mounjaro prescribing information, section 5.7 (DailyMed, US)
- Zepbound prescribing information, sections 5.8 and 17 (DailyMed, US)
- Trulicity prescribing information, section 5.7 (DailyMed, US)
- Saxenda prescribing information, section 5 (DailyMed, US)
- Victoza prescribing information, section 5 (DailyMed, US)
- Ozempic product monograph, sections 7 and 8 (Novo Nordisk Canada)
- Rybelsus product monograph, sections 7 and 8 (Novo Nordisk Canada)
- Wegovy product monograph, sections 7 and 8 (Novo Nordisk Canada)
- Mounjaro product monograph, section 7 and patient information (Eli Lilly Canada)
- Zepbound product monograph, section 7 (Eli Lilly Canada)
- Trulicity product monograph (Eli Lilly Canada)
- Victoza product monograph (Novo Nordisk Canada)
- Saxenda product monograph (Novo Nordisk Canada)
This page summarizes official product labels as general information. It is not medical advice. Do not start, stop or change any medication without talking to your prescriber. Labels are updated; check the current version for your product.
Frequently asked questions
Can Ozempic make diabetic retinopathy worse?
The US Ozempic label reports that in a 2-year trial of people with type 2 diabetes and high cardiovascular risk (SUSTAIN 6), diabetic retinopathy complications occurred in 3.0% on Ozempic vs 1.8% on placebo. The gap was larger in people who already had retinopathy (8.2% vs 5.2%) than in those without a known history (0.7% vs 0.4%). The label links this to rapid improvement in blood sugar, which has been associated with a temporary worsening of retinopathy.
What counts as a "diabetic retinopathy complication" in these trials?
In SUSTAIN 6 it was an adjudicated composite endpoint. The Canadian Ozempic monograph lists its four parts: need for retinal photocoagulation (laser), need for treatment with intravitreal agents (eye injections), vitreous hemorrhage, and diabetes-related blindness.
Does Mounjaro or Zepbound have a retinopathy warning?
Yes. Both US labels say temporary worsening of diabetic retinopathy has been reported with rapid improvement in glucose control and that people with a history of retinopathy should be monitored. The labels give no trial rate. The Canadian monographs add that tirzepatide has not been studied in non-proliferative retinopathy needing acute therapy, proliferative retinopathy or diabetic macular edema, and should be used with caution, with appropriate monitoring.
Do Saxenda and Victoza carry a retinopathy warning?
Not in the labels we checked on November 4, 2026. The US Saxenda and Victoza labels have no diabetic retinopathy section in Warnings and Precautions, and neither do the Saxenda and Victoza Canadian monographs (revised December 9, 2022). The Victoza monograph lists diabetic retinopathy only as an adverse event in its trial tables.
Is the Trulicity warning the same in Canada and the US?
No. The US Trulicity label (section 5.7) reports REWIND results: 1.9% on Trulicity 1.5 mg vs 1.5% on placebo over a median 5.4 years, and 8.5% vs 6.2% in people with a history of retinopathy. The Canadian Trulicity monograph we checked (revised July 5, 2024) does not contain a diabetic retinopathy warning.
Does Wegovy affect the eyes in people without diabetes?
The Wegovy warning is written for people with type 2 diabetes. In the US label, the weight-loss trial of adults with type 2 diabetes and a BMI of 27 or more reported diabetic retinopathy in 4% on Wegovy vs 2.7% on placebo. The Canadian monograph reports retinal disorders overall in 6.9% on Wegovy, 6.2% on semaglutide 1 mg and 4.2% on placebo in that trial.
What is NAION and is it the same as retinopathy?
No. NAION (non-arteritic anterior ischemic optic neuropathy) is damage to the optic nerve, not the retina. The Canadian Ozempic, Rybelsus, Mounjaro and Zepbound monographs say a person reporting sudden loss of vision, including partial loss, should be urgently referred for an eye exam and the drug stopped if NAION is confirmed. See our thyroid and contraindications guide for how this compares with the US labels.
Should I get an eye exam before starting a GLP-1?
The labels do not set an exam schedule. They say people with a history of diabetic retinopathy should be monitored for progression, and the Rybelsus monograph adds that they should be treated according to clinical guidelines. Ask your prescriber or eye doctor what monitoring makes sense for you, and tell them if you have retinopathy before you start.
What should I log if I notice vision changes?
The date, which eye, what changed (blurring, dark spots or floaters, a shadow, partial loss), whether it came on suddenly, and your recent doses and blood sugar readings. A GLP-1 tracker such as Glidedose keeps doses and symptoms on one timeline you can show your prescriber. Sudden loss of vision needs urgent care, not a log entry.
Related guides
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The thyroid C-cell tumor warning, MTC and MEN 2, and each label's warnings, US vs Canada.Tracking GLP-1 side effects
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US label windows plus all 8 Canadian monographs: Wegovy 3-day day-change, Victoza restart difference, and a date calculator.