NONARTERITIC anterior ischaemic optic neuropathy (NAION) is a serious condition that can lead to sudden vision loss and is a key concern for healthcare professionals managing diabetic patients. As the use of semaglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist, continues to rise among people with and without diabetes, the safety profile of this medication requires closer scrutiny. The findings of a recent study indicate an association between semaglutide and an increased risk of NAION in patients with diabetes, especially after longer usage durations, such as two years or more.
The cohort study used data from the TriNetX database, encompassing patients diagnosed with diabetes and prescribed semaglutide between October 2019, and December 2023, with no history of NAION prior to the study. The semaglutide cohort (n=174,584) was compared with a control group of diabetes patients prescribed non–GLP-1 receptor agonist antidiabetic medications. The primary outcomes assessed included the cumulative incidence of NAION and hazard ratios (HR) at various time points, such as 1, 2, 3, and 4 years.
The study found that patients with diabetes on semaglutide exhibited no significant risk for NAION up to 1 year. However, significantly increased risks were observed after 2 years (hazard ratio [HR] 2.39; 95% CI: 1.37–4.18), 3 years (HR 2.44; 95% CI: 1.44–4.12), and 4 years (HR 2.05; 95% CI: 1.26–3.34), Notably, individuals with diabetes who also had hypertension or a history of semaglutide prescriptions were at an even greater risk. These results suggest a need for heightened awareness and monitoring in patients prescribed semaglutide, especially for those with additional risk factors such as hypertension.
In conclusion, this cohort study highlights a potential association between semaglutide and increased NAION risk in diabetic patients. However, as the study is retrospective, causality cannot be definitively established, and further prospective studies are required to confirm these findings. Clinicians should be cautious when prescribing semaglutide, particularly to patients with known risk factors for NAION, and monitor their patients closely over time to mitigate potential vision-related complications.
Reference
Hsu AY et al. Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy Risk Among Patients With Diabetes. JAMA Ophthalmol. 2025;DOI: 10.1001/jamaophthalmol.2025.0349.
