Glucagon-like Peptide-1 Receptor Agonists and Risk for Ischemic Optic Neuropathy : A Target Trial Emulation.

Annals of Internal Medicine · 1 Sept 2026 · Observational Study

Reynolds, O'Malley + more

The abstract is read at the publisher; the summary is JClub's.

Glucagon-like peptide-1 receptor agonists increase the 18-month risk of ischemic optic neuropathy by approximately 3 to 3.6 cases per 10,000 patients compared to other diabetes medications.

Why it matters: Understanding potential eye-related risks of diabetes treatments is crucial, especially since ischemic optic neuropathy can cause significant vision loss, yet data on medication associations are limited.
What they did: The study used an observational emulation of a target trial with a large U.S. claims database, comparing 18-month ION incidence among 18-65-year-olds initiating GLP-1RAs, SGLT2is, or DPP4is, adjusting for over 80 covariates.
The result: Findings suggest GLP-1RA use is linked to a modestly higher risk of ION, particularly in men, older patients, and those with cardiovascular or eye conditions, though the absolute risk remains very low and causality uncertain.