JAMA Ophthalmol

More evidence that GLP-1 RA use ups the risk of optic nerve damage

August 5, 2025

Study details: A case-control study used MarketScan data (2006–2022) to assess the association between GLP-1 RA exposure and nonarteritic anterior ischemic optic neuropathy (NAION). Adults with NAION (n=65,612) were matched with up to 10 controls (n=641,751) by age, insurance year, and history of T2DM or obesity. GLP-1 RA exposure was categorized by ever-use and duration (1, 2, or ≥3 years) of dulaglutide, liraglutide, semaglutide, or exenatide.

Results: Any GLP-1 RA use was associated with a 19% increased odds ratio (OR) of NAION in the first year. Among patients without T2DM or obesity, GLP-1 RA use was associated with a twofold increase in NAION risk, with liraglutide showing the strongest association (OR 2.32; 95% CI, 1.04–5.20). Semaglutide use among patients with T2DM was associated with a 24% increased odds (95% CI, 0.93–1.66).

Clinical impact: GLP-1 RA therapy may be associated with an increased risk of NAION, particularly in patients with obesity. Consider ophthalmologic evaluation for at-risk individuals and weigh the therapeutic benefits against rare but serious ocular risks.

Source:

Nagdeve P, et al. (2025, July 24). JAMA Ophthalmol. GLP-1RA Exposure and Nonarteritic Anterior Ischemic Optic Neuropathy Prevalence by Diabetes Status. https://pubmed.ncbi.nlm.nih.gov/40705351/