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

Objective: To investigate the association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and nonarteritic ischemic optic neuropathy (NAION). Research Design and Methods: PubMed, Embase, and Cochrane Library were searched August 2025. Odds ratios (ORs) and absolute risk for NAION were pooled using random-effects Peto and inverse-variance models. Any ocular event was a secondary outcome. Results: 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 and nonrandomized studies. Absolute NAION risk in 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). Conclusions: GLP-1 RA was associated with a modest increase in NAION risk, but not overall ocular adverse events. Findings underscore the need for long-term post-marketing safety studies and should be interpreted against their well-established mortality and cardio-kidney-metabolic benefits.