Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy

The study conducted by Hathaway et al. in JAMA Ophthalmology explores the potential association between the use of semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), and the diagnosis of nonarteritic anterior ischemic optic neuropathy (NAION). The researchers analyzed data from their institution's clinical registry and compared two groups: patients with type 2 diabetes (T2D) and patients with obesity, both with and without semaglutide exposure. They found a temporal association between semaglutide prescription and the occurrence of NAION, with a higher likelihood of NAION within the first year of semaglutide use. NAION is a rare condition, and its pathogenesis is not fully understood. The study suggests that there may be unknown risk factors involved in the development of NAION that are not accounted for by traditional systemic risk factors. The authors recommend further research to confirm or refute the association and to determine the risk of repeat events or second eye involvement. Despite the potential risk, the authors do not discourage the use of GLP-1 RAs in T2D or obesity management, as they have shown significant benefits in glycemic control and cardiovascular outcomes.