Semaglutide use associated with NAION Risk among diabetes patients, suggests study

A new study published in the journal of Neurology revealed that semaglutide may increase the risk of non-arteritic anterior ischemic optic neuropathy (NAION) when compared to non-glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly in patients with diabetes. These findings highlight the need for further research and careful risk–benefit assessment in clinical practice.

The findings come from a comprehensive analysis of existing studies, drawing on data from more than 1.5 million patients. The research team reviewed five major studies comparing outcomes in people taking GLP-1RAs versus those who were not. Their goal was to clarify conflicting earlier reports about whether these medications might be associated with NAION.

With the help of advanced statistical modeling, this research found that semaglutide users had more than twice the risk of developing NAION when compared with non-users. Also, the relative risk was estimated at 2.52, and the probability that this increased risk was calculated at 99.9%, which suggested strong statistical confidence.

The signal appeared even stronger among patients with diabetes, the primary group prescribed these medications. In this subgroup, the risk remained elevated, with a relative risk of 2.41. While the absolute number of cases remains low, the pattern was consistent across multiple analyses.

The overall incidence of NAION among GLP-1RA users was estimated at 85 cases per 100,000 patients. Among those specifically taking semaglutide, the rate rose to 118 cases per 100,000. Though still considered a rare outcome, NAION is clinically significant because it can lead to permanent vision impairment.

The study also examined dulaglutide and exenatide, despite semaglutide accounting for the majority of cases observed. Sensitivity analyses consistently supported the main findings.

Despite the concerning signal, this research caution that the evidence is not definitive. The analysis relied largely on observational studies, which can identify associations but cannot prove direct causation. The overall certainty of the evidence was rated as low to moderate, meaning further high-quality research is needed.

Semaglutide and similar drugs have surged in popularity due to their effectiveness in controlling blood sugar and promoting weight loss. Clinicians may now need to weigh these benefits against a potential vision risk.

Overall, the findings of this study emphasize that patients should not stop taking prescribed medications without consulting their healthcare provider. The results also highlight the importance of monitoring visual symptoms and having informed conversations about treatment options.

Source:

Dhivagaran, T., Butt, F., Arunasalam, L., Bae, I., Mikhail, D., Tao, B. K., Xie, J. S., Balas, M., Popovic, M., & Margolin, E. (2026). Glucagon-like peptide-1 receptor agonists and risk of nonarteritic anterior ischemic optic neuropathy: Systematic review and meta-analysis. Neurology, 106(10), e214864. https://doi.org/10.1212/WNL.0000000000214864