Study Links Semaglutide Use to Increased Risk of NAION in Patients with Diabetes

A recent study published in JAMA Ophthalmology suggests an association between semaglutide use and an increased risk of nonarteritic anterior ischemic optic neuropathy (NAION) in patients with diabetes. NAION is a serious condition that can result in sudden, painless vision loss due to impaired blood flow to the optic nerve.

Cohort Study Evaluates Long-Term Risk

The study was led by Alan Y. Hsu, M.D., of China Medical University Hospital in Taichung City, Taiwan, and examined a large diabetic population to evaluate the potential relationship between semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA), and the risk of developing NAION.

Researchers conducted a cohort study comparing 174,584 patients with diabetes who were prescribed semaglutide to an equal number of patients using non-GLP-1 RA diabetes medications.

Increased Risk Emerges Over Time

The study found no increased risk for NAION in semaglutide users during the first year of treatment. However, at two, three, and four years after initiating semaglutide, the risk of developing NAION significantly increased:

       • 2-year hazard ratio (HR): 2.39

       • 3-year HR: 2.44

       • 4-year HR: 2.05

These findings suggest that the elevated risk of NAION becomes apparent with long-term use of semaglutide in patients with diabetes.

Risk Elevated in Hypertensive Patients and Ozempic Users

Further analysis revealed that diabetic patients with concomitant hypertension who were taking semaglutide faced a higher risk of NAION (HR: 2.42). The study also reported increased risk in patients with a history of Ozempic use, including those on stand-alone Ozempic therapy.

Interpretation and Caution

The authors emphasized that while the study identifies a statistical association between semaglutide use and NAION, the retrospective design does not confirm causality.

“Among patients with diabetes, an elevated risk of NAION was associated with semaglutide use compared with non-GLP-1 RA use,” the authors concluded. “However, the study's retrospective design can only infer associations rather than establish causality.”

References:

Alan Y. Hsu et al, Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy Risk Among Patients With Diabetes, JAMA Ophthalmology (2025). DOI: 10.1001/jamaophthalmol.2025.0349

Cindy X. Cai et al, Conflicting Results—Need for More Transparent and Reproducible Research, JAMA Ophthalmology (2025). DOI: 10.1001/jamaophthalmol.2025.0350