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Brilliant Board Review & CME
🎙️ Brilliant Medicine: Your Internal Medicine Edge
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Brilliant Board Review & CME
🎙️ 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.
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 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 there is a mechanism for this.
Speaker 1: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 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.