Are GLP-1s Linked to Optic Neuropathy?

A nationwide Swedish cohort found a higher relative risk of anterior ischemic optic neuropathy among GLP-1 receptor agonist users, but the overall risks were low.

By
Andrea Surnit
July 14, 2026
3 min

MDSpire News

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

Time Point	GLP-1 RA Risk	SGLT-2 Inhibitor Risk
1 Year	0.04%	0.02%
5 Years	0.12%	0.07%

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.