In the Literature

Summary of "Glucagon-Like Peptide-1 Receptor Agonist Medications and Nonarteritic Ischemic Optic Neuropathy: Is there cause for concern?"

Summary published April 28, 2025

Summary by Russell K. McAllister, MD; Tricia A. Meyer, PharmD

  • Nonarteritic ischemic optic neuropathy (NAION) is associated with ischemia of the optic nerve and is a leading cause of vision loss, especially in patients older than 50 years. The condition itself is not completely understood.
  • The incidence of NAION is very low and estimated to be approximately 2-10 per 100,000 individuals.
  • Glucagon-like peptide-1 receptor agonists (GLP1RA) have seen a marked increase in use beyond the management of diabetes, following evidence of reduced morbidity and mortality in patients with cardiovascular disease with the added positive effects on weight loss.
  • Within the past year, there have been a handful of studies and reports that have suggested an increased risk of NAION in patients that have been prescribed GLP1RA, such as semaglutide.
  • A single center retrospective matched cohort study of over 16,000 diabetic patients reported a 4.28-fold increased incidence of NAION in patients who were prescribed a GLP1RA versus those managed on other medication regimens.2
  • A retrospective study published in February 2025 of 14 large health databases with over 37 million patients with diabetes reported a more modest increase (incidence rate ratio of 1.32 to 1.5) in NAION in patients with Type II diabetes treated with semaglutide, much smaller than in the previous study.3
  • One additional study reported a doubled risk of NAION in diabetic patients treated with semaglutide.4
  • No data exists to link these findings to any increased risk of postoperative vision loss (POVL), however, it is an issue that should be monitored closely since ischemic optic neuropathy is the leading cause of POVL.
  • Due to the strong demonstrated benefits of GLP1RA medications in treatment of diabetes, obesity, and cardiovascular diseases and the extremely low incidence of NAION, the North American Neuro-Ophthalmology Society recommends that patients make no changes in their current use of GLP1RA medications.5
  • Further research is needed to reveal the true risk of NAION in patients taking GLP1RA medications.

REFERENCES

  1. Hattenhauer MG, Leavitt JA, Hodge DO, Grill R, Gray DT. Incidence of nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1997;123(1):103-7.
  2. Hathaway JT, Shah MP, Hathaway DB, et al. Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide. JAMA Ophthalmol. 2024;142(8):732-739.
  3. Cai CX, Hribar M, Baxter S et al. Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy. JAMA Ophthalmol. 2025:e246555.
  4. Grauslund J, Taha AA, Molander LD, et al. Once-weekly semaglutide doubles the five-year risk of nonarteritic anterior ischemic optic neuropathy in a Danish cohort of 424,152 persons with type 2 diabetes. Int J Retina Vitreous. 2024;10(1):97.
  5. https://www.nanosweb.org/files/Patient%20Brochures/English/Semaglutide_and_NAION_08212024.pdf