Do glucagon-like peptide-1 receptor agonists (GLP-1 RAs) increase the risk of nonarteritic ischemic optic neuropathy (NAION)? A meta-analysis published in Diabetes Care found that GLP-1 RA use was associated with a modestly higher NAION risk, while no increase was observed in overall ocular adverse events.

The analysis searched PubMed, Embase, and the Cochrane Library in August 2025 and included 15 longitudinal studies, comprising 8 clinical trials and more than 1.5 million patients. Odds ratios and absolute NAION risk were pooled using random-effects Peto and inverse-variance models. Any ocular event was evaluated as a secondary outcome.

Across included studies, GLP-1 RA use was associated with higher NAION risk versus comparators (OR 1.70; 95% CI 1.23-2.36). Findings were consistent across randomized studies (OR 2.36; 95% CI 0.85-6.53) and nonrandomized studies (OR 1.64; 95% CI 1.15-2.35), with no significant heterogeneity between study designs (P=0.51).

The absolute NAION risk in the GLP-1 RA group was 0.09%, corresponding to an absolute risk difference of 0.037% and an estimated number needed to harm of approximately 2,700. No association was identified for overall ocular adverse events (OR 0.95; 95% CI 0.86-1.05).

The findings suggest a small absolute increase in NAION risk with GLP-1 RAs, while overall ocular event rates were not elevated. The report noted that results should be considered alongside the established mortality and cardio-kidney-metabolic benefits of this drug class and support continued long-term postmarketing safety evaluation.