Association Between GLP-1 Receptor Agonists and Ischemic Optic Neuropathy: A Meta-analysis.

Abstract

To investigate the association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and nonarteritic ischemic optic neuropathy (NAION). The PubMed, Embase, and Cochrane Library databases were searched during August 2025. Odds ratios (ORs) and absolute risk for NAION values were pooled using random-effects Peto and inverse-variance models. Any ocular event was a secondary outcome. Fifteen longitudinal studies (8 trials; >1.5 million patients) were included. GLP-1 RA use was associated with higher NAION risk (OR 1.70; 95% CI 1.23-2.36), consistent across randomized (2.36; 0.85-6.53) and nonrandomized studies (1.64; 1.15-2.35) (P = 0.51, for heterogeneity). Absolute NAION risk in the GLP-1 RA group was 0.09%, corresponding to a 0.037% risk difference (number needed to harm ∼2,700). There was no association with overall ocular events (OR 0.95; 95% CI 0.86-1.05). GLP-1 RA use was associated with a modest increase in NAION risk but not overall ocular adverse events. Findings underscore the need for long-term postmarketing safety studies and should be interpreted against their well-established mortality and cardio-kidney-metabolic benefits.