GLP-1 receptor agonists and non-arteritic anterior ischaemic optic neuropathy: what an endocrinologist needs to know.

Abstract

Context: There is emerging evidence suggesting a possible association between glucagon-like peptide-1 receptor agonists (GLP-1 RA) and non-arteritic anterior ischaemic optic neuropathy (NAION) with retrospective cohort studies supporting this association reporting hazard ratios ranging from 2.19 to 7.74 when comparing exposed vs unexposed groups. This article explores the current research surrounding the risk of NAION with GLP-1 RA use in patients with type 2 diabetes and obesity, analyses patient factors that may increase susceptibility and highlights key areas warranting further research to guide endocrinologists in future prescribing.

Conclusions: Whilst the emerging evidence suggests a possible association between commencement of GLP-1 RAs and NAION, absolute risk remains low and needs to be balanced with the known substantial benefits of GLP-1 RAs. Further research is needed to investigate whether specific patient characteristics such as optic disc parameters, blood pressure changes, degree of weight loss or improvement of glycaemic control can assist clinicians in identifying those at higher risk.