Semaglutide and risk of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) in type 2 diabetes mellitus: A systematic review and meta-analysis.
Semaglutide use may be associated with an increased risk of Non-Arteritic Anterior Ischemic Optic Neuropathy in patients with type 2 diabetes, especially noted at 1-year follow-up with a hazard ratio of 3.36.
Where it sits
this study against the rest of the semaglutide corpusSummary and findings
This systematic review and meta-analysis evaluated the risk of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) in patients with type 2 diabetes mellitus using semaglutide compared to non-GLP-1 receptor agonists. A total of 12 studies were included, with a pooled hazard ratio (HR) indicating an increased risk of NAION associated with semaglutide use. The findings suggest a significant association that persists over time.
Abstract
<h4>Background</h4>The use of Glucagon-like peptide-1 receptor agonists (GLP-1RAs) has expanded dramatically worldwide, with semaglutide being one of the most widely utilized agents. Nonarteritic anterior ischemic optic neuropathy (NAION) has been associated with GLP-1RAs use from emerging pharmacovigilance data. This systematic review and meta-analysis sought to evaluate the risk of NAION in patients with type 2 diabetes mellitus (T2DM).<h4>Methods</h4>A literature search was made up to September 2025 (PROSPERO: CRD420251155026). Results were synthesized following the PRISMA guidelines and are presented as pooled Hazard Ratios (HR) with 95% confidence intervals (CI).<h4>Results</h4>Twelve studies were included; eight retrospective cohorts (14,255,247 participants) were meta-analyzed, with a mean age of 59.3 ± 15.9 years and 32.7% males. Patients with T2DM using semaglutide compared to non-GLP-1RAs showed an increased risk of NAION at 1-year follow-up with a pooled HR of 3.36 (95% CI: 1.44-7.84; p < 0.001; I<sup>2</sup> = 97%). At 2-year follow-up, the pooled HR was 2.37 (95% CI: 1.46-3.85; p < 0.001; I² = 0%). The 3-year risk after the sensitivity analysis showed a pooled HR of 2.37 (95% CI: 1.45-3.87, p < 0.001; I² = 28%), and the 5-year pooled HR was 2.37 (95% CI: 0.62-3.92; p < 0.001; I² = 0%).<h4>Conclusion</h4>This meta-analysis indicates a significant association between semaglutide use and NAION in patients with T2DM compared to non-GLP-1RAs, with this association remaining significant even after 5-years of semaglutide use.
Background
This paper addresses the potential ocular risk of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) in patients with type 2 diabetes mellitus treated with Semaglutide. Prior studies have suggested various adverse effects associated with GLP-1 receptor agonists, but the specific relationship between Semaglutide and NAION has not been thoroughly investigated. Understanding this risk is crucial for clinicians prescribing Semaglutide, particularly given the increasing use of this medication in diabetes management.
Methods
Not reported in abstract.
Results
Not reported in abstract.
Interpretation
Not reported in abstract.
Key findings
- Not reported in abstract.
Limitations
- Not reported in abstract.