Key Takeaways

  • The FDA's GLP-1 class-wide labeling changes address a potential association with NAION, although the condition remains rare and causation has not been established

  • Most research examining the association between GLP-1 medications and NAION has focused on semaglutide, leaving uncertainty about potential risks associated with other agents in the drug class

  • AAO and AOA emphasize prompt evaluation of sudden visual changes and individualized treatment decisions that balance potential ocular risks against the benefits of GLP-1 therapy

The American Academy of Ophthalmology (AAO), North American Neuro-Ophthalmology Society (NANOS), and American Optometric Association (AOA) have responded to the FDA's decision to require new safety warnings for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) regarding a potential increased risk of nonarteritic anterior ischemic optic neuropathy (NAION).

The AAO stated that the FDA's new analyses are broadly consistent with its May 2026 joint statement with NANOS, which concluded that GLP-1 RA use may be associated with NAION. However, the condition remains rare, any increase in absolute risk appears small, and causation has not been established.

"GLP-1 medications offer important benefits for people with diabetes, obesity, and heart disease, so our message to patients is simple. Don’t stop your medication without talking to your doctor, and if you notice sudden, painless vision loss in one eye, see an ophthalmologist promptly," Neuro-ophthalmologist Peter A. Quiros said on behalf of the AAO. 

The FDA's labeling changes apply across the GLP-1 RA drug class, although most published studies examining NAION risk have focused on semaglutide. Evidence regarding other GLP-1 medications remains limited, and differences in risk among individual agents and patient populations remain uncertain, AAO stated.

For patients who develop NAION while taking a GLP-1 medication, the FDA recommends considering discontinuation unless treatment benefits clearly outweigh the risks. The AAO and NANOS support individualized decision-making involving the patient, ophthalmologist, and prescribing clinician, taking into account the treatment indication, alternative therapies, and potential risk to the fellow eye.

The AOA similarly emphasized the importance of balancing the established health benefits of GLP-1 medications against potential ocular complications, while advocating a more proactive approach to eye care.

"The FDA's latest action reinforces a message the American Optometric Association (AOA) has consistently championed: Patients taking GLP-1 medications deserve proactive, comprehensive eye care as part of their overall health care," the association stated.

The AOA recommends a baseline, in-person comprehensive eye examination and appropriate follow-up care with a doctor of optometry for patients taking GLP-1 medications.

The organizations agree that patients should not discontinue GLP-1 medications without consulting their prescribing clinician and that sudden vision loss or other abrupt visual changes warrant prompt evaluation.

The AAO and NANOS said they will continue reviewing emerging evidence and updating their guidance as additional data become available.