Glucagon-like Peptide-1 Receptor Agonists and Risk for Anterior Ischemic Optic Neuropathy : A Nationwide Cohort Study
Authors' conclusion
The relative risk for AION was higher with GLP-1RA use compared with SGLT-2 inhibitor use in type 2 diabetes. However, absolute risks were small, and the RDs were substantially reduced in analyses restricted to patients receiving metformin to better account for confounding by diabetes severity, suggesting observed increases in risk may reflect residual confounding.
Study context
- Population
- Initiators of GLP-1 RAs or SGLT2i, Sweden, 2013 to 2024
- Participants
- 107,518 vs 185,898
- Exposure
- GLP-1 RA initiators vs SGLT2i initiators
- GLP-1RAn = 107,518
- SGLT-2 inhibitorn = 185,898reference
- Outcome
- Anterior ischemic optic neuropathy (AION) in the national patient register
Methodological detailspropensity score weighting, active comparator, Limitations: few outcome events, unmeasured confounding, limited generalizability to GLP-1RA users without diabetes
- Propensity score weighting
- Active comparator
- Limitations: few outcome events, unmeasured confounding, limited generalizability to GLP-1RA users without diabetes
Main finding
As reported in the abstract
AION · 1 year
Each group vs SGLT-2 inhibitorRD (95% CI)
GLP-1RA
0.02%(0.00%–0.03%)
Each group vs SGLT-2 inhibitorRelative risk (95% CI)
GLP-1RA
1.93(1.00–3.73)
Observational data: associations, not effects.
Further findings
AION risk, patients receiving metformin at baseline · 1, 3 and 5 years
- Differences substantially attenuated in analyses restricted to patients receiving metformin at baseline
Original publication
Glucagon-like Peptide-1 Receptor Agonists and Risk for Anterior Ischemic Optic Neuropathy : A Nationwide Cohort Study. Ann Intern Med. Published 14 July 2026. doi:10.
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