GLP-1 receptor agonist exposure and non-arteritic anterior ischaemic optic neuropathy: an illustrative case.

CLINICAL RELEVANCE: Non-arteritic anterior ischaemic optic neuropathy may occur following exposure to glucagon-like peptide-1 receptor agonists, although a causal relationship has not been established.

BACKGROUND

Recent evidence has raised concern regarding a possible association between glucagon-like peptide-1 receptor agonists and non-arteritic anterior ischaemic optic neuropathy. We describe an illustrative case occurring in a younger patient without diabetes mellitus or hypertension.

METHODS

A 37-year-old woman with obesity and insulin resistance developed painless unilateral visual loss following three once-weekly doses of semaglutide, all administered before symptom onset. Clinical examination, multimodal ophthalmic imaging, visual field testing, neuroimaging, and laboratory investigations were performed.

RESULTS

The right eye showed optic disc oedema, a dense inferior altitudinal visual field defect, and marked peripapillary retinal nerve fibre layer thickening, supporting a diagnosis of non-arteritic anterior ischaemic optic neuropathy. Investigations excluded alternative inflammatory, demyelinating, infectious, arteritic, compressive, and pseudopapilloedema-related causes. At three months, the optic disc oedema had resolved with residual pallor, while the visual field defect persisted.

CONCLUSIONS

Although causality cannot be established from a single case, recent glucagon-like peptide-1 receptor agonist exposure may be relevant when evaluating atypical optic neuropathy in younger patients.