🎙️ Episode 31: Semaglutide and the Eye: NAION Signal in Sight.

🧪 Key Insights:

Observational data links semaglutide (GLP-1 RA) to increased risk of non-arteritic anterior ischemic optic neuropathy (NAION).

Incidence: ~9–15 cases per 100,000 patient-years.

Possible mechanism: GLP-1 receptors in optic nerve ganglion cells.

No proven causality yet — retrospective study only.

🧩 Clinical Takeaway:

Risk remains very low.

Discuss with patients who have eye disease or prior NAION before initiating therapy.

Transcript

Semaglutide and Optic Neuropathy Link

Speaker 1 0:01

let's talk about smaglutide in optic neuropathy . We're specifically talking about non-arteric anterior ischemic optic neuropathy , a rare cause of blindness very rare and it looks like there's an association with glucagon-like peptide 1 receptor antagonist , specifically smaglutide , and this has been noted on observational studies . So this was a cohort study with propensity scoring matching versus empagliflozin , which is what that's , the SGL2

Higher Incidence Rates Compared to SGLT2s

Speaker 1 0:35

inhibitor , and semaglutide and exaglutide exposures associate with significantly higher incidence . Now , what was the higher incidence ? It's 9 to 15 per 100,000 patient years , so it's still low , but it's a rare thing . And what they think is happening is there's a presence of a GLP-1 receptor in ganglion cells which help form the optic nerve , so

Potential Mechanism and Clinical Implications

Speaker 1 1:09

there is a mechanism for this .

Speaker 1 1:10

Now , does there need to be more studies ? Yes , is it something you need to run down and tell your patients ? Oh my gosh , you need to stop this medication because of this . And we know the benefits of the glucagon like peptide 1 receptor agonist . We know the GL of the glucagon like peptide 1 receptor agonist . We know the GLP-1s . We know how important they are and the good things that they offer . Is there something we need to inform our patients of ? Yes , and inform them that future studies are pending on this . But this was in a good journal , jama of Ophthalmology . So this is something to think about , and as we learn more and more about these medications , more and more will come out about

Weighing Benefits Against New Concerns

Speaker 1 1:48

them , both good and bad , and this is something that we need to look at and see if there's a risk that can be mitigated with this .