Recent real-world data shows no significant link between semaglutide or other GLP-1 receptor agonists and vision loss due to NAION.
Background and Recap
In late 2024, questions were raised about a possible link between semaglutide and a rare cause of vision loss known as nonarteritic anterior ischemic optic neuropathy (NAION). These concerns were based on a small observational study that reported a higher incidence of NAION in patients with type 2 diabetes or obesity taking semaglutide. The risk appeared highest in the first year of use.
Because NAION can lead to sudden and often irreversible vision loss, the study prompted closer examination of the relationship between GLP-1 receptor agonists and ischemic optic neuropathies. At the time, limited data and inconsistent findings left the issue unresolved.
What the New Study Adds
A new, large-scale U.S. study published in The American Journal of Ophthalmology offers more clarity. Researchers analyzed electronic health record data from more than 116 million patients across 65 healthcare institutions using the TriNetX platform. The study included patients with type 2 diabetes or high BMI (≥25) who were prescribed semaglutide or another GLP-1 receptor agonist, and compared them to matched controls not taking GLP-1 medications.
Key findings:
- In patients with type 2 diabetes, the 5-year risk of NAION was 0.065% for those on semaglutide — not significantly different from matched controls.
- In patients with high BMI, the 2-year risk of NAION was 0.038%, again showing no increased risk.
- Similar results were found when looking at the broader category of ischemic optic neuropathy (ION), which includes NAION and other forms.
- The study also included a negative control (allergic contact dermatitis) to validate the findings and found no unexpected differences.
Why This Study Matters
Unlike earlier studies with small, localized populations, this analysis:
- Draws from a large, diverse U.S. population, increasing generalizability.
- Includes only patients with documented ophthalmology or neurology visits, improving diagnostic accuracy.
- Excludes cases related to giant cell arteritis (GCA), the main cause of arteritic ION, to focus specifically on nonarteritic cases.
The study also examined outcomes at multiple time points (1, 3, and 5 years), allowing for a better understanding of short- and long-term risks.
Takeaway for Patients and Providers
Current evidence does not show an increased risk of NAION or ION in people taking semaglutide or other GLP-1 receptor agonists. While any new or worsening vision symptoms should be evaluated promptly, this large U.S. study supports the safety of these medications from an ophthalmologic perspective.
The findings are especially important for people considering semaglutide for diabetes, weight management, or cardiovascular risk reduction. The low overall incidence of NAION — even in high-risk groups — should also be factored into any treatment discussions.
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