Ophthalmology · 2026
Cup-To-Disc Ratio in Glucagon-Like Peptide 1 Receptor Agonist-Associated Nonarteritic Anterior Ischemic Optic Neuropathy.
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Robertson Christian M, Fung Derrick S, Smith Kyle H, Lai Kevin E, Guniganti Ridhima R, Rizzo Joseph F, Lao Kenneth C, Disc-at-Risk Study Group
Аннотация
PURPOSE: To determine whether the cup-to-disc ratio (CDR) of patients with glucagon-like peptide 1 receptor agonist (GLP-1 RA) -associated nonarteritic anterior ischemic optic neuropathy (NAION) is similar to the CDR of patients with NAION without GLP-1 RA exposure and to stratify the odds of developing NAION based on CDR.
DESIGN: A retrospective, multicenter, case-control study of the CDR of NAION cases diagnosed between 2018 and 2024.
SUBJECTS AND CONTROLS: The Disc-at-Risk Study Group included 16 neuro-ophthalmology centers that reviewed medical records of 1812 unaffected fellow eyes from 2169 consecutive patients with NAION. The control group included both eyes of 465 patients.
METHODS: The study compared the unaffected fellow eyes of 3 groups of patients with NAION: semaglutide users (117 eyes), nonsemaglutide GLP-1 RA users (83 eyes), and No GLP-1 RA medications (1612 eyes). Control eyes defined the distribution of CDR in the general population.
MAIN OUTCOME MEASURES: The CDR of unaffected fellow eyes of patients with NAION with and without exposure to GLP-1 RA medications.
RESULTS: The average provider-estimated CDR in unaffected fellow eyes of patients with NAION was 0.13, with no significant difference among the 3 groups. A measured CDR ≤ 0.40 was found in 94% of fellow eyes but only 56% of controls (P < 0.001). A measured CDR ≤ 0.20 was found in 54% of fellow eye photographs but only 9% of controls (P < 0.001). Eyes with a measured CDR ≤ 0.20 have the highest NAION odds (odds ratio = 46.3; 95% confidence interval, 22.9-93.4), and eyes with a CDR > 0.20 and ≤0.40 had more modest odds (odds ratio = 6.8; 95% confidence interval, 3.5-13.2) compared with eyes with a measured CDR > 0.40.
CONCLUSIONS: Patients with NAION with and without exposure to GLP-1 RA medications have the same high prevalence of crowded optic discs. The odds of NAION are inversely proportional to CDR. Irrespective of GLP-1 RA exposure, eyes with a photo-measured CDR ≤ 0.20 have 46 times greater odds of NAION than eyes with a CDR > 0.40. Although the absolute risk of NAION is low, this quantification of NAION risk may help better inform patients concerned about NAION risk. This study does not assess whether GLP-1 RA medications are an independent risk factor for NAION.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: A retrospective, multicenter, case-control study of the CDR of NAION cases diagnosed between 2018 and 2024.
SUBJECTS AND CONTROLS: The Disc-at-Risk Study Group included 16 neuro-ophthalmology centers that reviewed medical records of 1812 unaffected fellow eyes from 2169 consecutive patients with NAION. The control group included both eyes of 465 patients.
METHODS: The study compared the unaffected fellow eyes of 3 groups of patients with NAION: semaglutide users (117 eyes), nonsemaglutide GLP-1 RA users (83 eyes), and No GLP-1 RA medications (1612 eyes). Control eyes defined the distribution of CDR in the general population.
MAIN OUTCOME MEASURES: The CDR of unaffected fellow eyes of patients with NAION with and without exposure to GLP-1 RA medications.
RESULTS: The average provider-estimated CDR in unaffected fellow eyes of patients with NAION was 0.13, with no significant difference among the 3 groups. A measured CDR ≤ 0.40 was found in 94% of fellow eyes but only 56% of controls (P < 0.001). A measured CDR ≤ 0.20 was found in 54% of fellow eye photographs but only 9% of controls (P < 0.001). Eyes with a measured CDR ≤ 0.20 have the highest NAION odds (odds ratio = 46.3; 95% confidence interval, 22.9-93.4), and eyes with a CDR > 0.20 and ≤0.40 had more modest odds (odds ratio = 6.8; 95% confidence interval, 3.5-13.2) compared with eyes with a measured CDR > 0.40.
CONCLUSIONS: Patients with NAION with and without exposure to GLP-1 RA medications have the same high prevalence of crowded optic discs. The odds of NAION are inversely proportional to CDR. Irrespective of GLP-1 RA exposure, eyes with a photo-measured CDR ≤ 0.20 have 46 times greater odds of NAION than eyes with a CDR > 0.40. Although the absolute risk of NAION is low, this quantification of NAION risk may help better inform patients concerned about NAION risk. This study does not assess whether GLP-1 RA medications are an independent risk factor for NAION.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.