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.

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.

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.