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

At a Glance

Category	Detail
Condition	Anterior Ischemic Optic Neuropathy
Key Mechanisms	Association with glucagon-like peptide-1 receptor agonists versus sodium-glucose cotransporter-2 inhibitors.
Target Population	Patients with type 2 diabetes
Care Setting	Nationwide, register-based cohort study

Key Highlights

GLP-1 receptor agonists associated with a higher risk of anterior ischemic optic neuropathy compared to SGLT-2 inhibitors.
Absolute risks at 1 year were 0.04% for GLP-1 and 0.02% for SGLT-2.
At 5 years, risks were 0.12% for GLP-1 and 0.07% for SGLT-2.
Differences in risk were reduced in patients receiving metformin.
Residual confounding cannot be excluded.

Guideline-Based Recommendations

Diagnosis

Anterior ischemic optic neuropathy identified through national patient register.

Management

Consider diabetes severity and metformin use when evaluating risks.

Monitoring & Follow-up

Monitor for signs of anterior ischemic optic neuropathy in patients using GLP-1 receptor agonists.

Risks

Low absolute risks of anterior ischemic optic neuropathy in patients using GLP-1 receptor agonists.

Patient & Prescribing Data

Patients with type 2 diabetes initiating GLP-1 receptor agonists or SGLT-2 inhibitors.

Cautious interpretation of risk increase among GLP-1 users due to low absolute event rates.

Clinical Best Practices

Assess individual patient risk factors when prescribing GLP-1 receptor agonists.
Utilize propensity score weighting to balance demographic and clinical characteristics.