Glucagon-like peptide-1 receptor agonists and the risk of nonarteritic anterior ischemic optic neuropathy: Evidence from a global real-world cohort
Authors' conclusion
GLP-1 RA therapy was associated with a modest but statistically significant increased risk of NAION. While the absolute risk remains low, clinicians should consider ophthalmic risk assessment-particularly in patients with anatomical susceptibility or vascular risk factors-as GLP-1 RA use expands for diabetes and obesity management. Further mechanistic and prospective research is warranted.
Study context
- Population
- Adults (≥18 years) with T2D, TriNetX U.S. Collaborative Network 2015–2024; preexisting optic neuropathy or severe ocular disease excludedmatched cohorts
- Exposure
- GLP-1 RA users vs other antidiabetic users; GLP-1 RA users vs SGLT2i users
- Other antidiabeticn = 799,036reference
- SGLT-2in = 429,985reference
- Outcome
- Incident NAION, defined by ICD-10 codes
Methodological detailspropensity-score matched (1:1), TriNetX U.S. Collaborative Network
- Propensity-score matched (1:1)
- TriNetX U.S. Collaborative Network
Main finding
As reported in the abstract
Cumulative NAION incidence · Over 9 years
Hazard ratio (95% CI)
GLP-1 RAvs Other antidiabetic0.21% vs 0.17%; matched 799 036 vs 799 036
1.38(1.23–1.55)
GLP-1 RAvs SGLT-2i0.20% vs 0.20%; matched 429 985 vs 429 985
1.30(1.11–1.52)
Observational data: associations, not effects.
Further findings
- Sensitivity analyses yielded similar patterns
Original publication
Glucagon-like peptide-1 receptor agonists and the risk of nonarteritic anterior ischemic optic neuropathy: Evidence from a global real-world cohort. Diabetes Metab. Published 11 February 2026. doi:10.
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