People taking a GLP-1 medicine for type 2 diabetes or weight management are being reassured by the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) that they do not need to stop or delay their treatment following this week’s safety update from the Therapeutic Goods Administration (TGA).
The update strengthens warnings across the GLP-1 receptor agonist class, which includes semaglutide, liraglutide, dulaglutide and tirzepatide, about a rare eye condition – non-arteritic anterior ischaemic optic neuropathy (NAION) – that can cause sudden vision loss.
GLP-1 medicines are widely used to treat type 2 diabetes and obesity, with strong evidence of benefit for glycaemic control, weight reduction and cardiovascular risk management.
Professor Dame Helen Danesh-Meyer, RANZCO Fellow and President of the Neuro Ophthalmology Society of Australia, said: “Our message to patients is simple: this is a rare event, so please don’t stop your medication because of this update. Know the warning signs, and if you have any concerns, talk to your doctor.
Our message to patients is simple: this is a rare event, so please don’t stop your medication because of this update
“It’s also worth remembering that overweight, obesity, and poorly controlled diabetes are themselves major risk factors for a range of serious eye diseases, including diabetic retinopathy, which remains a far more common cause of vision loss than NAION.
“By helping patients manage their weight and blood sugar, GLP-1 medicines can actually reduce these more common risks to sight, on top of their broader benefits for heart health and other weight-related conditions.”
A causal link between GLP-1 medicines and NAION has not been established, and reported estimates of any risk vary widely across studies. However, given that a potential association has been identified, RANZCO supports increased awareness among both patients and clinicians of the data and the symptoms of NAION.
Patients should seek urgent medical treatment if they notice sudden, painless loss of vision, or a blank or blurred patch in their vision, while taking a GLP-1 medicine. Most people will never experience this rare complication, and RANZCO does not recommend routine eye examinations before starting a GLP-1 medicine, nor stopping treatment based on the appearance of the optic nerve alone.
RANZCO’s Advice To Clinicians And Patients
- Do not stop GLP-1 RA treatment solely because of concern about NAION. Routine discontinuation is not supported by current evidence.
- Routine ophthalmic screening before starting a GLP-1 RA is not required for patients who do not have diabetes or visual symptoms, and there is no automatic contraindication based on optic-disc appearance alone.
- An individualised risk–benefit discussion is recommended for patients with a previous episode of NAION, marked optic-disc crowding, or multiple vascular risk factors, involving the prescribing clinician and, where appropriate, an ophthalmologist or neuro ophthalmologist.
- Patients should seek urgent ophthalmic review if they experience sudden, painless loss of vision or a visual-field defect while taking a GLP-1 RA.
- Patients with diabetes should stay up to date with retinal examinations, as diabetic retinopathy remains a far more common cause of vision loss than NAION.
- Clinicians are asked to remain vigilant for suspected cases of NAION and to report them through national pharmacovigilance systems.
“RANZCO continues to call for further research, particularly prospective studies and pooled analyses of randomised trial data with adjudicated ocular outcomes, to clarify the size and clinical significance of any risk,” said Professor Danesh-Meyer said. “In the meantime, for most patients, the well-established cardiometabolic benefits of GLP-1 therapy continue to outweigh this rare potential risk.
“RANZCO’s position statement on GLP-1 receptor agonists and NAION sets out the research on this issue in detail, along with clear, practical guidance on the use of these medications, which we’ve provided to ophthalmologists, GPs, optometrists and other health professionals.
“We welcome the TGA’s action as a sensible, proportionate response, and will keep working with prescribing clinicians and patient groups to make sure this rare risk is well understood, without discouraging the appropriate use of these important medicines.”
References
Danesh- Meyer, H, Rizzo, J (2026). Is there a causal link between GLP-1 Receptor agonists and non-arteritic anterior ischaemic optic neuropathy? A critique of the clinical evidence. Clinical and Experimental Ophthalmology 54, no. 4 (2026): 554–564. Clinical & Experimental Ophthalmology 54, no. 4 (2026): 554–564, doi. 10.1111/ceo.70096.
RANZCO position statement – GLP1 receptor agonists and non-arteritic anterior ischaemic optic neuropathy (NAION). Available at ranzco.edu/wp-content/uploads/2026/04/RANZCO-Position-Statement-GLP1-Receptor-Agonists-and-Non-Arteritc-Anterior-Ischaemic-Optic-Neuropathy-NAION.pdf [accessed July 2026].
