Abstract
Purpose :
Non-arteritic anterior ischemic optic neuropathy (NAION), the most common acute optic neuropathy in those over 50 years old, is not well understood and causes irreversible blindness. Phosphodiesterase inhibitors and amiodarone have been hypothesized to increase the risk of NAION. With an increase in GLP-1R (glucagon-like peptide receptor) agonists for weight loss since FDA approval in 2021, our group noted a previously unreported rise in NAION cases in GLP-1R agonist users at a specialty eye hospital.
Methods :
Matched retrospective cohort study with propensity score matching 1:5, examining the association between the GLP-1R agonist and the development of NAION from December 1, 2017 through November 30, 2023 in the neuro-ophthalmology clinic at a specialty eye hospital. The patients with no prior NAION events were identified from a centralized clinical data registry and patients were matched by cardiovascular risk factors, contraindications, and indications for the use of this GLP-1R agonist. The incidence rate and the hazard ratio were calculated with the use of Cox regression, with adjustment for matching factors including age, sex and cardiovascular risk factors.
Results :
From a total of 17,292 patients, 6426 unique patients were identified to have risk factors for NAION and 307 were prescribed and dispensed GLP-1R agonists. Of those, 30 patients were diagnosed with NAION (incidence rate 4.83). From the 1236 patients in the non-GLP1R agonist-exposed cohort, 88 patients were diagnosed with NAION (incidence rate 1.05), RR= 4.59 (p=0.02). A Cox regression analysis showed significantly higher risk (exp(coef) = 3.24, p < 0.001 in the GLP-1R agonist group. Males had a higher risk of NAION compared to females (exp(coef) = 1.74, p = 0.003), Diabetes (exp(coef) = 1.60, p = 0.035) as well as those with hyperlipidemia (exp(coef) = 1.68, p = 0.032). The model's overall significance was confirmed by the likelihood ratio test, Wald test, and score (logrank) test, all showing highly significant p-values (p= <0.001)
Conclusions :
This study found that the hazard of NAION is 3.24 times higher in individuals exposed to the GLP-1R agonists compared to those who were not after adjusting for confounders. Clinicians and patients may consider this risk before initiating this GLP-1R agonists in those with history of NAION, monocular patients, and those with low vision at baseline.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.