Semaglutide Use and Risk of Diabetic Retinopathy and Non-Arteritic Anterior Ischemic Optic Neuropathy in Type 2 Diabetes: A Single-Center Retrospective Cohort Study.

BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), including semaglutide, are increasingly adopted for type 2 diabetes mellitus (T2DM) due to improvements in glycemic control and weight loss. Although concerns have been raised about a potential association with non-arteritic anterior ischemic optic neuropathy (NAION), this relationship remains uncertain.

OBJECTIVE AND METHOD: In this single-center retrospective cohort study, we reviewed patients with T2DM treated with semaglutide at Rajavithi Hospital. A Kaplan-Meier time-to-event analysis was conducted to estimate the incidence of NAION and proliferative diabetic retinopathy (PDR) progression.

RESULTS

Among 100 patients with T2DM treated with semaglutide, no cases of NAION were observed over 299 person-years of follow-up (crude incidence rate: 0 per 1,000 person-years; 95% CI: 0-6.17). PDR and diabetic macular edema (DME) were the main findings, accounting for 10.00% and 3.00%, respectively. Ophthalmic complications group (13 patients) demonstrated higher body mass index (23.72 ± 1.38 vs 21.18 ± 2.51 kg/m2; p < 0.001), higher fasting plasma glucose (197.77 ± 48.28 vs 148.70 ± 27.84 mg/dL; p < 0.001), and worse baseline best-corrected visual acuity ([BCVA]; 1.71 ± 0.74 vs 0.45 ± 0.39 logarithm of the Minimum Angle of Resolution [logMAR]; p < 0.001). Final BCVA remained significantly worse in the complication group (p < 0.001). Ophthalmic complication remained stable over the 60-month follow-up; longer diabetes duration (>60 months) was modestly associated with better survival (log-rank p = 0.049). By contrast, other demographic, optic disc characteristics, and concomitant systemic vascular diseases were not significantly linked to ophthalmic complication.

CONCLUSIONS

No NAION events were observed over 299 person-years; however, the limited sample size precludes definitive conclusions about NAION risk. A modest trend toward higher proliferative diabetic retinopathy rates suggests that ophthalmic monitoring may be warranted in at-risk patients. Larger prospective studies are needed to confirm these preliminary findings.