GLP-1 Users May Face Optic Nerve Damage Risk in First Year

TOPLINE:

The use of GLP-1 receptor agonists, and particularly liraglutide, was associated with an increased risk of developing nonarteritic anterior ischemic optic neuropathy (NAION) during the first year of treatment, with the risk being most pronounced in individuals without type 2 diabetes (T2D) or obesity.

METHODOLOGY:

• Researchers conducted a case-control study to examine the association between the use of GLP-1 agents and development of NAION.
• They analyzed data from 65,612 patients with NAION who had obesity, T2D, or neither and matched them with 641,751 control participants by age, exact year of insurance enrollment, and history of T2D or obesity.
• Exposure to GLP-1 was defined by use (ever or never) and duration of continuous use (1, 2, or ≥ 3 years), according to dispensed prescriptions for dulaglutide, liraglutide, semaglutide, or exenatide.

TAKEAWAY:

• The use of any GLP-1 agent was associated with 19% higher odds of developing NAION in the first year (odds ratio [OR], 1.19; 95% CI, 1.02-1.39), with the use of liraglutide tied to an even greater risk for the condition (OR, 1.53; 95% CI, 1.18-1.98).
• The association between exposure to a GLP-1 drug and development of NAION was stronger in people without T2D or obesity using any of these medications (OR, 2.03; 95% CI, 1.07-3.85) and especially liraglutide (OR, 2.32; 95% CI, 1.04-5.20).

IN PRACTICE:

“The aforementioned associations for extended semaglutide use and liraglutide use among individuals without obesity or T2D are interesting, given these medications are increasingly being used for weight management,” the researchers reported. “Future research including reasons for GLP-1RA [receptor agonists] use among this group and larger sample sizes could clarify whether these associations exist in this population or result from obesity or T2D diagnosis exposure misclassification or low exposure prevalence in this study,” they added.

SOURCE:

This study was led by Pallavi Nagdeve, MPH, and Russell Griffin, PhD, of the University of Alabama in Birmingham, Alabama. It was published online on July 24, 2025, in JAMA Ophthalmology.

LIMITATIONS:

The use of standard diagnostic codes may have led to misclassification of other optic neuropathy cases as NAION. Information available from the database used in this study was limited, and the reported associations may have been biased by unknown factors.

DISCLOSURES:

This study did not report any source of funding. The authors reported having no relevant financial conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.