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Association between Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy
Open accessAbstract
Purpose To investigate whether semaglutide increases the risk of nonarteritic anterior ischemic optic neuropathy (NAION) in the general population.Design This retrospective cohort study used a deidentified global electronic medical records database. The enrollment period was extended from January 2017 to August 2023, with observations concluding in August 2024.Participants This study included individuals with type 2 diabetes mellitus (T2DM) or obesity. They were further categorized into T2DM-only, obesity-only, and T2DM with obesity groups to assess the differences among these subgroups. The effects of semaglutide were compared with those of glucose-lowering or weight-loss medications other than glucagon-like peptide receptor agonists.Methods Patient data were obtained from 160 health care organizations across 21 countries. Outcomes were evaluated at 1, 2, and 3 years of follow-up. A 1:1 propensity score matching was performed to balance age, sex, body mass index, hemoglobin A1C, medications, and underlying comorbidities. Cox regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs).Main outcome measures The occurrence of NAION.Results The final analysis included 37 314 participants with T2DM only, 129 690 participants with obesity only, and 130 216 participants with both T2DM and obesity. The results indicated that the administration of semaglutide was not associated with the development of NAION in the T2DM-only group (1-year follow-up: HR, 2.32; 95% CI, 0.60-8.97; 2 years: HR, 2.31; 95% CI, 0.86-6.17; 3 years: HR, 1.51; 95% CI, 0.71-3.25), the obesity-only group (1-year follow-up: HR, 0.41; 95% CI, 0.08-2.09; 2 years: HR, 0.67; 95% CI, 0.20-2.24; 3 years: HR, 0.72; 95% CI, 0.24-2.16), and the T2DM with obesity group (1 year follow-up: HR, 0.81; 95% CI, 0.42-1.57; 2 years: HR, 1.2; 95% CI, 0.74-1.94; 3 years: HR, 1.19; 95% CI, 0.78-1.82).Conclusions The findings suggest that semaglutide may not be associated with an increased risk of NAION in the general population. Therefore, avoidance of semaglutide based solely on concerns regarding the risk of NAION may not be warranted because its potential benefits for blood glucose control and cardiovascular health likely outweigh its potential risks.Financial disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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“Although such an association has not been confirmed by other studies, 92,93”
From GLP-1 receptor agonists and next-generation incretin-based medications: metabolic, cardiovascular, and renal benefits (2026) · cites this paper as [92]
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“Studies show conflicting associations.2,3,4,5,6,7,8,9”
From New-Onset Nonarteritic Anterior Ischemic Optic Neuropathy and Initiators of Semaglutide in US Veterans With Type 2 Diabetes (2026) · cites this paper as [6]
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“Large observational analyses reported similar 2- to 3-fold risks,2,3,4,5 whereas others observed attenuated or null associations.6,7,8,9”
From New-Onset Nonarteritic Anterior Ischemic Optic Neuropathy and Initiators of Semaglutide in US Veterans With Type 2 Diabetes (2026) · cites this paper as [6]
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“A separate study evaluated this relationship among patients from 21 different countries and found no significant difference in the risk of NAION in high BMI and diabetic patients prescribed semaglutide.”
From The Effect of Semaglutide and GLP-1 RAs on Risk of Nonarteritic Anterior Ischemic Optic Neuropathy (2025) · cites this paper as [32]
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“Our conclusions align with those of Chou et al, who found no association between semaglutide and NAION.”
From The Effect of Semaglutide and GLP-1 RAs on Risk of Nonarteritic Anterior Ischemic Optic Neuropathy (2025) · cites this paper as [32]
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“some studies have not found any increase in the risk of NAION in individuals using semaglutide or other GLP-1RAs (94, 95).”
From The science of safety: adverse effects of GLP-1 receptor agonists as glucose-lowering and obesity medications (2026) · cites this paper as [95]
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The Effect of Semaglutide and GLP-1 RAs on Risk of Nonarteritic Anterior Ischemic Optic Neuropathy
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Metadata
- Authors
- Chou, C.-C., Pan, S.-Y., Sheen, Y.-J., Lin, J.-F., Lin, C.-H., Lin, H.-J., Wang, I.-J., & Weng, C.-H.
- Affiliations
- National Yang Ming Chiao Tung University (TW)
- Taichung Veterans General Hospital (TW)
- Fu Jen Catholic University (TW)
- China Medical University (TW)
- Brown University (US)
- Corresponding author
- Weng, Chien-Hsiang
- Venue
- Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2025-04
- Volume
- 132
- Issue
- 4
- Pages
- 381-388
- ISSN
- 0161-6420 (ISSN-L)
- OpenAlex
- W4403999311
- Semantic Scholar
- aa78f19846444c79d2357846888082679c194abf
- Cited by
- 104
- References
- 26
- Citations by year
- 2026: 46 · 2025: 56
- FWCI
- 34.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Taichung Veterans General Hospital (TCVGH-1136902B)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Ophthalmology › Drug-Induced Ocular Toxicity
- Health Sciences › Medicine › Ophthalmology › Glaucoma and retinal disorders
- Keywords
- semaglutide, nonarteritic anterior ischemic optic neuropathy, type 2 diabetes, obesity, drug safety, adverse event risk, anti-obesity drugs, glucose-lowering medications, propensity score matching, hazard ratio, real-world evidence
- MeSH terms
- Semaglutide, Adult, Aged, Diabetes Mellitus, Type 2, Glucagon-Like Peptides, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Middle Aged, Obesity, Retrospective Studies, Risk Factors, Incidence, Optic Neuropathy, Ischemic, Glucagon-Like Peptide 1
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