JAMA Netw Open

Semaglutide and tirzepatide may slightly increase risk of optic nerve disorders in T2DM

August 15, 2025

Study details: A nationwide, propensity score–matched cohort study emulated target trials using U.S. electronic health records from December 2017 to January 2023. The analysis included 159,398 patients with T2DM and no prior eye disorders, comparing those prescribed semaglutide or tirzepatide (n = 79,699) with those receiving other antidiabetic agents.

Results: During 2-year follow-up, semaglutide or tirzepatide was associated with a higher risk of first-time nonarteritic anterior ischemic optic neuropathy (NAION) (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.01–3.07; 0.04% vs. 0.02%) and other optic nerve disorders (HR, 1.65; 95% CI, 1.18–2.31; 0.12% vs 0.07%) compared with controls. No increased risk was observed for other visual pathway disorders. Absolute event rates were low.

Clinical impact: Semaglutide or tirzepatide may confer a modestly increased risk of NAION and other optic nerve disorders in patients with T2DM, though the absolute risk remains low. Consider close ophthalmic monitoring in patients initiating these agents, especially those with additional risk factors for optic neuropathy.

Source:

Wang L, et al. (2025, August 1). JAMA Netw Open. Semaglutide or Tirzepatide and Optic Nerve and Visual Pathway Disorders in Type 2 Diabetes. https://pubmed.ncbi.nlm.nih.gov/40788646/