Semaglutide Linked to Doubled Risk of Rare Optic Neuropathy in Veterans Study
A nationwide study of US veterans with type 2 diabetes found semaglutide initiation more than doubled the risk of nonarteritic anterior ischemic optic neuropathy compared to SGLT2 inhibitors, though absolute risk remained low at 0.29%.
A nationwide study of US veterans with type 2 diabetes found that semaglutide initiation was associated with more than double the risk of nonarteritic anterior ischemic optic neuropathy compared with SGLT2 inhibitor initiation over a median 2.1-year follow-up. However, absolute risk remained low at 0.29% versus 0.13%, respectively.
The study included 102,361 US veterans with type 2 diabetes, including 11,478 initiators of semaglutide and 90,883 initiators of a sodium-glucose cotransporter-2 inhibitor. Over a maximum follow-up of 7.5 years, 173 total incident NAION events occurred.
The incidence rate of NAION was 123 per 100,000 person-years among semaglutide initiators and 67 per 100,000 person-years among comparator patients. Semaglutide initiators had a 2.33-fold higher risk than comparator patients (hazard ratio, 2.33; 95% CI, 1.54-3.54; P < .001).
The overlap weighted incidence rate of NAION was 0.29% for semaglutide initiators and 0.13% for comparator patients, representing a difference of 0.16 percentage points. Overall, baseline characteristics were well balanced, with a mean age of 60.1 years and 85.5% male participants.
Nonarteritic anterior ischemic optic neuropathy is a rare condition caused by reduced blood flow to the optic nerve, leading to sudden and sometimes permanent vision loss. Semaglutide, a glucagon-like peptide-1 receptor agonist, has become a cornerstone therapy for type 2 diabetes and weight management, with millions of patients benefiting from improved glycaemic control and cardiovascular outcomes.
Although the absolute risk remains low, the findings highlight an important safety consideration for semaglutide prescribing. Clinicians should counsel semaglutide users to report any sudden visual changes promptly, and weigh therapy choices carefully in patients with preexisting optic nerve risk factors.
Further research is needed to confirm causality, identify high risk groups, and guide monitoring strategies. Improved awareness among prescribers and ophthalmologists may support earlier detection and better patient outcomes.
The findings were published in JAMA Ophthalmology in February 2026. The study represents emerging evidence that has raised concerns about potential ocular complications as semaglutide use expands globally. Understanding its safety profile, including rare adverse effects, has become increasingly important for clinicians and patients.
The Medicines and Healthcare products Regulatory Agency acknowledged that semaglutide can cause non-arteritic anterior ischemic optic neuropathy. This occurs when blood flow to the nerves of the eye become blocked, causing vision loss. Wegovy prescriptions now come with a safety warning as to the risk of blindness.