Semaglutide use linked to partially reversible bilateral NA-AION and branch retinal artery occlusion
Background
Non-arteritic anterior ischemic optic neuropathy (NA-AION) is the most common acute optic neuropathy in adults, causing sudden, painless vision loss due to impaired blood flow to the optic nerve head. While its exact etiology is often multifactorial, conditions like diabetes, hypertension, and sleep apnea are risk factors. Current treatments are limited, focusing on managing underlying systemic conditions. Recent observational data on semaglutide and NA-AION have been conflicting, prompting further investigation into potential ocular adverse events associated with GLP-1 receptor agonists. This case report adds to the sparse literature on this rare but serious complication.
Study Design
This retrospective case report details the clinical course of a 37-year-old obese male with no known systemic diseases who developed ocular symptoms after 11 months of semaglutide use. The patient presented with sudden vision drop in the right eye and blurred vision in the left. Ophthalmic examinations included best-corrected visual acuity (BCVA), relative afferent pupillary defect (rAPD) assessment, and dilated fundus examination. The primary endpoint was the change in visual acuity and optic disc appearance following the discontinuation of semaglutide.
Results
After 11 months of semaglutide use, the patient presented with severe vision impairment, notably a BCVA of 6/200 in the right eye and 20/25 in the left eye. A significant rAPD of 0.9 log units was observed in the right eye. Dilated fundus examination revealed bilateral optic disc swelling, more pronounced in the right eye, alongside an inferior macular ischemia indicative of BRAO in the right eye.
One month after discontinuing semaglutide, the patient showed marked improvement, with
BCVArecovering to 20/30 in the right eye and 20/20 in the left eye.Fundus examinationalso confirmed substantial improvement in bilateral disc swelling, with both eyes showing small optic nerve heads. This suggests a partial reversibility of the optic neuropathy and retinal artery occlusion upon cessation of the drug.
Key Findings
- A 37-year-old obese male developed bilateral NA-AION and unilateral BRAO after 11 months of semaglutide use.
- Initial
BCVAwas 6/200 (right eye) and 20/25 (left eye), with 0.9 log unitsrAPDin the right eye. Fundus examinationshowed bilateral optic disc swelling and inferior macular ischemia in the right eye.- One month post-semaglutide discontinuation,
BCVAimproved to 20/30 (right eye) and 20/20 (left eye). - Optic disc swelling significantly improved in both eyes after semaglutide cessation, indicating partial reversibility.
Why It Matters
Clinicians should consider baseline ocular assessments, including optic nerve and retinal examinations, before initiating semaglutide, especially in patients with pre-existing risk factors for vascular events. While rare, this case highlights a potential, partially reversible adverse event that could impact patient safety and quality of life. For peptide users, this underscores the importance of reporting any sudden visual changes to their healthcare provider promptly. This finding doesn't alter current dosing protocols but emphasizes vigilance for a rare side effect, suggesting that careful monitoring may be warranted. The reversibility observed offers a critical insight for management.
semaglutide
na-aion
brao
optic-neuropathy
retinal-artery-occlusion
adverse-event