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Semaglutide Use and Risk of Diabetic Retinopathy and Non-Arteritic Anterior Ischemic Optic Neuropathy in Type 2 Diabetes: A Single-Center Retrospective Cohort Study. Kemchoknatee P(1), Pakaymaskul P(1), Piyawannarat N(1). Author information: (1)Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand. BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs), including semaglutide, are increasingly adopted for type 2 diabetes mellitus (T2DM) due to improvements in glycemic control and weight loss. Although concerns have been raised about a potential association with non-arteritic anterior ischemic optic neuropathy (NAION), this relationship remains uncertain. OBJECTIVE AND METHOD: In this single-center retrospective cohort study, we reviewed patients with T2DM treated with semaglutide at Rajavithi Hospital. A Kaplan-Meier time-to-event analysis was conducted to estimate the incidence of NAION and proliferative diabetic retinopathy (PDR) progression. RESULTS: Among 100 patients with T2DM treated with semaglutide, no cases of NAION were observed over 299 person-years of follow-up (crude incidence rate: 0 per 1,000 person-years; 95% CI: 0-6.17). PDR and diabetic macular edema (DME) were the main findings, accounting for 10.00% and 3.00%, respectively. Ophthalmic complications group (13 patients) demonstrated higher body mass index (23.72 ± 1.38 vs 21.18 ± 2.51 kg/m2; p < 0.001), higher fasting plasma glucose (197.77 ± 48.28 vs 148.70 ± 27.84 mg/dL; p < 0.001), and worse baseline best-corrected visual acuity ([BCVA]; 1.71 ± 0.74 vs 0.45 ± 0.39 logarithm of the Minimum Angle of Resolution [logMAR]; p < 0.001). Final BCVA remained significantly worse in the complication group (p < 0.001). Ophthalmic complication remained stable over the 60-month follow-up; longer diabetes duration (>60 months) was modestly associated with better survival (log-rank p = 0.049). By contrast, other demographic, optic disc characteristics, and concomitant systemic vascular diseases were not significantly linked to ophthalmic complication. CONCLUSIONS: No NAION events were observed over 299 person-years; however, the limited sample size precludes definitive conclusions about NAION risk. A modest trend toward higher proliferative diabetic retinopathy rates suggests that ophthalmic monitoring may be warranted in at-risk patients. Larger prospective studies are needed to confirm these preliminary findings. © 2026 Kemchoknatee et al. PMCID: PMC13674446 Conflict of interest statement: The authors report no conflicts of interest in this work.
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