Expert consensus suggests mild link between GLP-1 receptor agonists and rare optic nerve disorder

A new consensus from North American ophthalmology societies indicates a potential small increase in NAION risk associated with GLP-1 drugs like semaglutide, though evidence remains inconclusive and treatment decisions should be personalised.

A new expert consensus from the North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology says glucagon-like peptide-1 receptor agonists, particularly semaglutide, may be linked to a small increase in the risk of a rare sight-threatening optic nerve disorder, but the evidence is not strong enough to prove cause and effect.

The statement, published in Ophthalmology, reviews the available research on non-arteritic anterior ischemic optic neuropathy, or NAION, a condition that reduces blood flow to the optic nerve and can cause sudden vision loss. The authors say the overall signal points to a possible modest risk increase, but they stress that NAION remains uncommon and that the absolute risk for most patients taking GLP-1 drugs is still low.

The document comes after a May 2026 meta-analysis in Neurology found semaglutide was associated with a relative risk of 2.52 for NAION compared with non-GLP-1 treatment, with the strongest signal seen in people with diabetes. But the ophthalmology experts note that the wider evidence base is inconsistent: some studies suggest a higher risk, while others show no clear association. Much of the research relies on electronic health records, claims databases and other observational methods that are prone to bias and missing data.

That uncertainty has made treatment decisions difficult for clinicians and patients. The consensus statement says shared decision-making is essential when considering whether to start, continue or stop a GLP-1 drug in someone who has NAION or may be at risk. It also stops short of backing a blanket recommendation to discontinue semaglutide, even though the European Medicines Agency advised in June 2025 that it should be stopped in all patients with NAION. The American groups argue that automatic discontinuation could be harmful for people who depend on these medicines for hard-to-control diabetes or significant cardiovascular disease.