NAION Occurs in about 1 in a thousand

[lessthanhalf]

Nonarteritic anterior ischemic optic neuropathy (NAION), occurs in around one in a thousand patients on semaglutide.

Abstract only unfortunately

Glucagon-like Peptide-1 Receptor Agonists and Risk of Nonarteritic Anterior Ischemic Optic Neuropathy

Systematic Review and Meta-Analysis https://www.neurology.org/doi/10.1212/WNL.0000000000214864

For some reason I thought it was quite a bit more rare than that. But 118 cases out of 100,000 on semaglutide is not that rare. This study does not talk about incidence with newer agents , just semaglutide and older, but the data will be better for semaglutide as it has been around for longer. From other things I have seen it may be less common with tirz or reta, but not drastically so.

For someone using GLP's to treat life long severe obesity a 1/1000 chance of losing eyesight in an eye is probably an acceptable risk, but for bodybuilders?. I already thought this was an issue thinking it was more like 1 in ten thousand or 100 thousand, but at those odds it really needs to be thought about.

 

[Retract8740]

Not too much to go on with just the abstract, but it seems like the risk is more for people using GLP-1RAs with diabetes. Did I read that right?

 

[lessthanhalf]

I looked up what I could on google scholar as I found this result hard to believe, despite the huge numbers included, and discussed it with chatgpt.

It found there was significant variation in the odds between the studies, which suggests the numbers are not really that bad, and most of the large number of studies on google scholar had single digit numbers of citations, which makes it hard to work out which results are viewed as being reliable, and the results were anywhere from no increase to one in a 1000 or so.

NAION is more common in older people, with diabetes, sleep apnoea, high blood pressure and vascular disease, so there really is a lot of room for confounding variables, as many of those are related to obesity or diabetes, which increases the odds of being prescibed GLP's, and of getting NAION which makes determining causation more difficult.

It does suggest that the risks in younger less overweight people using GLP drugs are lower than in those with diabetes or more severe obesity or obesity with health complications using GLP drugs, but it does not really give much of an idea of what those risks actually are in the less overweight group.

What is an acceptable risk of blindness in an eye for someone who is only a bit overweight?

 

[5byfive]

They way I understand it is that there is a good increase in relative risk but the absolute risk is still very small. Everyone has a risk of developing it, but it is very small. If you double that risk (which is what has been suggested), it is still very small. So if you are at higher risk, it might go from 1% to 2%. If you are at low risk, it may me more like. 1% to .2% (as an example, I haven't seen anything about what the risk is in healthy people). So someone that is very healthy may not be taking on much additional risk for the benefit.

 

[myopicmystic]

In general I think AION including NAION has an incidence around 10 per 100,000, which correlates to your 1 in 10,000 number.

This study reviews diabetic vs non diabetic overweight patients being prescribed semaglutide

https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255

As for acceptable risks, it’s hard to say. Hopefully giving people this information helps them make informed decisions though

 

[woundcarping]

I’m also curious about the timing of the NAION vs starting the GLP. When I was learning about this originally one thought was rapidly decreasing blood sugar levels being a possible cause, which I’d assume was a more front loaded risk, perhaps reducing below untreated baseline, perhaps.

I saw my eye doc in the wild last month and ask if I had elevated risk factors for NAION.

As best I know, it’s mainly a crap shoot.