To assess the risk of non-arteritic anterior ischemic optic neuropathy (NAION) in patients with type 2 diabetes mellitus (T2DM) and obesity using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) compared to those not receiving these medications.

NAION is associated with vascular irregularities and may be a potential complication in individuals with risk factors such as T2DM and obesity. While GLP-1 RAs are widely prescribed for these conditions, their potential influence on NAION risk remains unclear due to limited evidence.

This cohort study utilized electronic medical records from the TriNetX Global Collaborative Network. Two cohorts were analyzed: one comprising patients with T2DM and obesity receiving GLP-1 RAs and another receiving other antidiabetic medications, excluding GLP-1 RAs. Propensity score matching was applied to balance demographic and clinical characteristics. The primary outcome was the incidence of NAION over a three-year follow-up period. Risk difference (RD) and risk ratio (RR) were calculated to compare NAION incidence between groups.

A total of 88,293 patients were included across both cohorts, with mean follow-up durations of 554 days for the GLP-1 RAs cohort and 771 days for the non-GLP-1 RAs cohort. NAION incidence was <0.1% (43 cases) in the GLP-1 RAs cohort and 0.1% (45 cases) in the non-GLP-1 RAs cohort. The RD between cohorts was not statistically significant (p = 0.832), and the RR was 0.956 (95% CI: 0.629–1.452; p > 0.05), indicating no significant difference in NAION risk between groups.

NAION is a rare outcome in patients with T2DM and obesity, and the use of GLP-1 RAs does not appear to increase its risk. Further research is needed to confirm these findings and explore underlying mechanisms.