SGLT2 inhibitors are linked to slower diabetic retinopathy progression

The edition in brief

The systemic drug a diabetic patient takes may matter to their eyes. A meta-analysis of 16 studies and 1.78 million patients found SGLT2 inhibitors associated with lower progression of diabetic retinopathy (relative risk 0.77, 95% CI 0.72 to 0.82) and diabetic macular oedema (0.75, 0.69 to 0.82) versus other glucose-lowering agents, with the clearest advantage over sulfonylureas. Benefit scaled with baseline risk — about a 4% absolute reduction where retinopathy rates were 20%. This is observational, but it is a reason for ophthalmologists to support SGLT2 inhibitors in the systemic conversation for patients with established eye disease. In diabetic macular oedema, the COED trial compared a dexamethasone implant plus aflibercept against aflibercept alone. Combination gave similar vision and anatomy but resolved oedema a median of 12 weeks sooner and needed about one fewer injection, at the cost of more cataract progression and raised intraocular pressure. It is an option to reduce injection burden in selected pseudophakic eyes, not a routine default. On safety, a meta-analysis of 834,814 anti-VEGF injections put the rhegmatogenous retinal detachment risk at roughly 1 in 8,675 per injection, or about 1 in 1,250 per eye over a treatment course — a reassuring but non-zero figure for consent. The ESCRS 2024 cataract guidelines remain the current reference, recommending intracameral antibiotics and NSAID cover among 32 evidence-based points.