Clinical Report: Are GLP-1s Linked to Optic Neuropathy?

Overview

This study investigates the association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and anterior ischemic optic neuropathy (AION) among patients with type 2 diabetes. A higher relative risk was observed for GLP-1 RA users compared to those on SGLT-2 inhibitors, while the absolute risks remained low.

Background

The potential ocular risks associated with GLP-1 receptor agonists are of increasing concern as their use becomes more widespread in managing type 2 diabetes. This study contributes to the evaluation of the safety profile of GLP-1 RAs.

Data Highlights

Key Findings

• Anterior ischemic optic neuropathy occurred in 62 patients on GLP-1 RAs and 64 on SGLT-2 inhibitors.
• At 1 year, the absolute risks were 0.04% for GLP-1 RAs and 0.02% for SGLT-2 inhibitors.
• At 5 years, the absolute risks were 0.12% for GLP-1 RAs and 0.07% for SGLT-2 inhibitors.
• The primary analysis indicated a 78% higher likelihood of AION in GLP-1 RA users compared to SGLT-2 inhibitors.
• Differences in risk were substantially reduced in analyses restricted to patients receiving metformin.
• Residual confounding could not be excluded despite adjustments for various factors.

Clinical Implications

Clinicians should be aware of the potential increased risk of anterior ischemic optic neuropathy in patients using GLP-1 receptor agonists, although the absolute risk remains low.

Conclusion

The findings indicate an association between GLP-1 receptor agonists and anterior ischemic optic neuropathy, highlighting the need for further investigation.

Related Resources & Content

1. Ueda P, et al., Annals of Internal Medicine, 2024 -- Are GLP-1s Linked to Optic Neuropathy?
2. Glaucoma Physician — The Impact of GLP-1 Receptor Agonists on Ocular Disease
3. Retinal Physician — GLP-1 Receptor Agonists Linked to Increased nAMD Risk
4. Optometric Management — GLP-1 Receptor Agonists in Glaucoma Care
5. The Impact of GLP-1 Receptor Agonists on Ocular Disease
6. GLP-1 Receptor Agonists Linked to Increased nAMD Risk
7. label
8. Semaglutide NAION risk_2025-06_EMA communication
9. Glucagon-Like Peptide-1 Receptor Agonists and the Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Consensus Statement by the North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology - Ophthalmology
10. WNL-2025-205108 1..11
11. Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide | Diabetic Retinopathy | JAMA Ophthalmology | JAMA Network