For older adults with type 2 diabetes, glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is associated with nonarteritic anterior ischemic optic neuropathy (NAION), according to a research letter published online July 31 in JAMA Ophthalmology.
Kin Wah Fung, M.D., from the National Institutes of Health in Bethesda, Maryland, and colleagues conducted an observational cohort study involving Medicare enrollees aged 65 years or older with type 2 diabetes to examine the association between use of GLP-1 RAs and NAION. Patients using GLP-1 RAs were compared to patients using other antidiabetic medications; GLP-1 RAs were first assessed as a class and then as individual drugs with propensity score adjustment.
A total of 3,845,171 patients with type 2 diabetes were included; 15.1% were prescribed GLP-1 RAs (6.6% dulaglutide, 4.9% semaglutide, 4.2% liraglutide, and 2.1% exenatide); 34.8% were prescribed metformin; and 21.7% were prescribed insulin. The researchers found that 7,660 patients (0.2%) developed NAION during a median follow-up of 3.7 years.
The use of any GLP-1 RA was associated with an increased risk for NAION compared with other second-line antidiabetic medications (hazard ratio, 1.15). There was a median of 3.3 years between initiation of GLP-1 RA use and incidence of NAION. An increased risk for NAION was seen in association with two GLP-1 RAs (hazard ratios, 1.39 and 1.25 for semaglutide and liraglutide, respectively).
“The risk of NAION warrants further research given the increasing use of GLP-1 RAs and the seriousness of NAION,” the authors write.
More information:
Kin Wah Fung et al, GLP-1 RAs and Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Older Patients With Diabetes, JAMA Ophthalmology (2025). DOI: 10.1001/jamaophthalmol.2025.2299
Citation:
GLP-1 receptor agonist use linked to nonarteritic anterior ischemic optic neuropathy ( 5)
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