Small NAION Risk from GLP-1 Therapy Not Yet Worth Drug Discontinuation, Experts Say

NAION is a rare condition, and the research has demonstrated that the overall risk for NAION remains low, even among patients taking semaglutide. Photo: Michael Trottini, OD, and Candice Tolud, OD. Click image to enlarge. The use of GLP-1 receptor agonist drugs has become increasingly common and will likely become more common with the recent FDA approval of oral semaglutide. Recent studies have reported a possible association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and non-arteritic anterior ischemic optic neuropathy (NAION). Still, available evidence primarily includes retrospective observational studies, many of which rely on analysis of electronic health records and administrative claims data and are subject to limitations. The North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology recently provided a summary of the existing literature in an article in Ophthalmology. Their joint consensus statement concluded that the existing literature indicates a possible small increased risk of NAION in patients taking semaglutide, but the risk remains low and is yet to be confirmed; causation has not been shown.“Shared decision-making between the patient and their care team is indicated to decide whether to start, continue or discontinue GLP-1 therapy in the setting of a new diagnosis of NAION or in certain risk contexts, considering the individual patient characteristics and clinical scenario,” the guidance article authors wrote. “Until more evidence is available, in this individualized risk and benefit decision-making, one should not assume that this risk is specific to semaglutide.”Taken in total, the summary noted that currently available evidence suggests a possible association between semaglutide and NAION. Still, further studies are needed to confirm this risk, and causality has not been established. New evidence is emerging rapidly, and the results of future studies may alter the current conclusions.“Any estimated increase in relative risk must be interpreted in the context of the low overall incidence of NAION; even a several-fold elevation in relative risk is only a small absolute risk difference,” the article explained.The North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology did distinguish that discontinuing GLP-1 therapy could pose significant health risks for some patients, such as those with obesity, those whose diabetes has been difficult to manage with other therapies or those with cardiovascular comorbidities.Instead, the two groups recommend careful weighing of risks and benefits and discussion between the patient and their care team to make an informed decision. This discussion should consider the individual's risk factors, overall health and alternative therapeutic options. Collaboration among the care team members is essential. The eyecare practitioner should communicate the small possible risk of NAION, while acknowledging that a causal association with GLP-1 drugs has not been established, to other members of the care team to better inform prescribing decisions.Click here for the source. DeParis SW, Oke I, Gaier ED, et al. Glucagon-like peptide-1 receptor agonists and the risk of non-arteritic anterior ischemic optic neuropathy: a consensus statement by the North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology. Ophthalmology. May 14, 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.