FDA adverse event reporting data point to formulation- and sex-specific associations between semaglutide and ischaemic optic neuropathy, with higher reporting odds in males and with obesity-dose semaglutide, according to a commentary by Muir and colleagues in the British Journal of Ophthalmology.

The authors describe an ocular evidence base that remains mixed. They cite observational studies linking GLP-1 receptor agonists to reduced risks of nonexudative age-related macular degeneration and noninfectious uveitis, while also noting a 3-year study in patients with diabetes that found a twofold increase in neovascular AMD among those prescribed GLP-1 RAs, with higher risk reported at longer durations of use.

The commentary highlights pharmacovigilance findings suggesting higher reporting odds of ischaemic optic neuropathy in males and with obesity-dose semaglutide compared with diabetes-dose semaglutide, while stressing that the broader ocular picture remains unclear and requires further study.

As anti-obesity medication use grows, including potential long-term use and increasing use in younger patients, the authors say more nuanced safety data will be needed to clarify retinal and optic nerve effects over time.

They also point to expert recommendations to screen patients with diabetes for diabetic retinopathy before starting GLP-1 RAs, discuss possible ocular risks in patients with sight loss in one eye or a history of ischaemic optic neuropathy, and report suspected adverse events through the yellow card system.

The authors declared no competing interests.

Source: British Journal of Ophthalmology