Original Investigation

Semaglutide or Tirzepatide and Optic Nerve and Visual Pathway Disorders in Type 2 Diabetes

JAMA Network Open 10.1001/jamanetworkopen.2025.26327

August 11, 2025 at 11:00 AM EDT

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Is treatment with either semaglutide or tirzepatide associated with an increased risk of nonarteritic anterior ischemic optic neuropathy and other optic nerve and visual pathway disorders?This cohort study emulated target trials among 1 511 637 eligible patients with type 2 diabetes by comparing treatment with either semaglutide or tirzepatide vs other antidiabetic medications. Semaglutide or tirzepatide was associated with increased risk of nonarteritic anterior ischemic optic neuropathy and other optic nerve disorders, but the overall risk was low.This analysis of patient electronic health record data suggests an increased risk of optic nerve disorders associated with semaglutide or tirzepatide in patients with type 2 diabetes, highlighting the need for close monitoring of these conditions.

Corresponding Authors: Rong Xu, PhD, Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Sears Tower T304, 10900 Euclid Ave, Cleveland, OH 44106-7288 (rxx@case.edu).

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