Non-Arteritic Anterior Ischemic Optic Neuropathy in an Otherwise Healthy Young Adult Patient Treated with Liraglutide and Semaglutide for Weight Loss: A Cautionary Tale.

Purpose: To report a case of non-arteritic ischemic optic neuropathy (NAION) in an otherwise healthy patient treated with Glucagon-Like Peptide-1 (GLP-1) receptor agonists (RAs) liraglutide and semaglutide.

Observations: A 47-year-old Caucasian female with a Body Mass Index (BMI) of 27.92, and no known history of diabetes, hypertension, or ischemic heart disease, developed a progressive decline in visual acuity in the right eye one month after initiating liraglutide therapy for weight loss. Upon symptom presentation, ophthalmic examination performed elsewhere revealed a best-corrected visual acuity (BCVA) of 20/40, optic nerve head (ONH) swelling, and inferior hemifield scotoma on Humphrey Visual Field testing. Oral corticosteroids were prescribed and discontinued because of poor glycemic control. Liraglutide therapy was continued for further three months and then switched to semaglutide owing to poor clinical results. Eight months later, the patient discontinued weight loss therapy because of progressive visual deterioration and presented to our clinic for a second opinion. Upon examination, BCVA was limited to 20/400, ONH edema was evident and confirmed on optical coherence tomography (OCT), and further worsening of the visual field defects was detected. Given the absence of anatomical and/or systemic risk factors, NAION secondary to GLP-1 RAs was diagnosed.

Conclusion and importance: In our patient, liraglutide likely served as the initial trigger for the NAION, with semaglutide acting as an additional contributing factor in the progression of the disease. This case adds to the complex puzzle regarding the association between GLP-1 RAs therapy and NAION. Given the increasing use of these drugs for both obesity and diabetes and the close temporal correlations between GLP-1 RAs use and NAION, healthcare providers should be aware of the possible risk of serious ocular complications. Upon onset of visual symptoms, early ophthalmologic diagnosis and treatment interruption are essential to prevent or limit severe visual morbidities.