The Risk of Non-arteritic Anterior Ischemic Optic Neuropathy (NAION) and Worsening Diabetic Retinopathy (DR) with Semaglutide

Abstract

Semaglutide, a GLP-1RA (receptor agonist), is being increasingly used for type 2 diabetes mellitus (T2DM) and weight management, broadening its clinical reach. While there has been a rapidly expanding scope, market, and exposed population for semaglutide, there have also been growing voices of concern on its retinal effects. For a clinical risk benefit analysis, reviewed here is the available scientific evidence and metanalysis of semaglutide and its ophthalmic effects. GLP‐1RAs are often associated with rapid reduction in blood sugar levels, which may lead to the development of anterior ischemic optic neuropathy of the non-arteritic type (NAION), or the progression of diabetic retinopathy (DR), with semaglutide possibly being separately associated with these eye effects, as seen in clinical studies. However, there are other co-existent risks that contribute to these ophthalmic complications, and there are large studies to show greater benefit to risk ratio of semaglutide in the population. Therefore, it is immensely important to assess individual risk factors, patient history, comorbidities, disease duration, lab parameters as well as concomitant medicines, for each patient separately, along with a thorough baseline eye checkup including a detailed retina evaluation, while deciding on GLP-1RA especially semaglutide therapy for T2DM or for weight reduction. This can enable the drug to be used effectively providing the desired clinical benefit, with the right caution and minimizing of adverse retinal effects.