April 24, 2026
1 min read
Key takeaways:
- Nonarteritic anterior ischemic optic neuropathy risk was 2.33 times higher with semaglutide.
- Clinicians need to evaluate visual symptoms and consider ocular risk factors.
Semaglutide was associated with more than twice the risk for nonarteritic anterior ischemic optic neuropathy compared with SGLT2 inhibitors, although the absolute risk “remained low,” according to a study published in JAMA Ophthalmology.
“Although [semaglutide is] effective for glycemic control, weight loss and cardiovascular risk reduction, nonarteritic anterior ischemic optic neuropathy (NAION) has emerged as a serious rare adverse event,” Kent Heberer, PhD, data scientist at the U.S. Department of Veterans Affairs, and colleagues wrote. “Studies show conflicting associations.”
Heberer and colleagues emulated a target trial using nationwide VA data. The analysis included 102,361 veterans with type 2 diabetes, including 11,478 prescribed semaglutide and 90,883 prescribed a sodium-glucose cotransporter 2 (SGLT2) inhibitor.
The researchers compared the incidence of NAION between the two treatment groups across a median follow-up period of 2.1 years.
Overall, the two groups had 173 new cases of NAION. The incidence rate was higher among patients taking semaglutide (123 per 100,000 person-years) than those taking SGLT2 inhibitors (67 per 100,000 person-years).
Compared with SGLT2 inhibitors, patients taking semaglutide had 2.33 times greater risk for NAION (P < .001). After adjusting for covariates, the researchers found an overlap-weighted cumulative absolute risk of 0.3% with semaglutide and 0.1% with SGLT2 inhibitors.
The researchers emphasized that the “absolute incidence remains low,” with about one additional case of NAION for every several thousand patients treated.
“As clinicians inform patients on semaglutide’s meaningful cardiometabolic benefits, they should also counsel on NAION as a rare, serious vision-loss event,” Heberer and colleagues wrote. “Consistent with recent commentaries, clinicians should encourage prompt evaluation of visual symptoms and consider ocular risk factors (eg, optic nerve disease, prior NAION). Ophthalmologists should identify semaglutide use in patients with NAION, who should inform their prescribing clinicians.”
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