1:30min
The Therapeutic Goods Administration (TGA) has issued a safety update about a potential association between glucagon-like peptide-1 receptor agonist medicines—commonly known as GLP-1 RAs—and non-arteritic anterior ischaemic optic neuropathy (NAION).
NAION is a rare but serious condition that can cause sudden and potentially permanent vision loss. There is currently no treatment shown to improve visual acuity outcomes following NAION.
GLP-1 RA medicines are primarily used to manage type 2 diabetes and obesity. Products currently marketed in Australia include:
- Trulicity (dulaglutide)
- Ozempic and Wegovy (semaglutide)
- Mounjaro (tirzepatide)
- Saxenda (liraglutide)
The Product Information for these medicines has been updated to include warnings about reported cases of NAION. The TGA advises that sudden vision loss, including partial loss of vision, requires urgent ophthalmological assessment.
What optometrists should do
Optometrists should:
- remain alert to the updated warnings and ask patients presenting with sudden or unexplained vision loss whether they are currently using, or have recently used, a GLP-1 RA medicine;
- treat sudden partial or complete vision loss as an ocular emergency and undertake an appropriate and timely clinical assessment;
- urgently refer patients with suspected NAION for ophthalmological examination and management, in accordance with established emergency referral pathways;
- promptly communicate relevant clinical findings to the patient’s ophthalmologist, general practitioner and prescribing practitioner;
- advise patients not to delay urgent assessment while waiting to speak with their usual healthcare provider;
- document the patient’s medication history, symptoms, examination findings, advice, referrals and communication with other practitioners; and
- report suspected medicine-related adverse events to the TGA.
For semaglutide medicines, the updated Product Information states that treatment should be discontinued if NAION is confirmed. Decisions about discontinuing or changing a patient’s medicine should be coordinated with the prescribing practitioner, unless immediate action is otherwise clinically required within the optometrist’s scope of practice.
The TGA also notes that an anatomical predisposition sometimes described as a “disc at risk” may be assessed by an optometrist or ophthalmologist. However, the alert does not establish a requirement for routine screening of every asymptomatic person taking a GLP-1 RA. Clinical assessment and follow-up should be based on the individual patient’s presentation, ocular findings and broader risk profile.
Discussing the alert with patients
Patients using a GLP-1 RA should be advised to seek urgent medical attention if they experience sudden vision loss or a sudden partial loss of vision.
Patients should not be unnecessarily alarmed or advised to cease treatment solely because they are taking a GLP-1 RA and do not have symptoms. Optometrists should explain that NAION is rare, while reinforcing that any sudden change in vision requires urgent assessment.
Further information
Members are encouraged to read the full TGA safety alert and Medicine Safety Update, including the updated Product Information wording:
- GLP-1 RAs and rare vision disorder
- GLP-1 RAs and rare, but severe, eye disorders
- The TGA has also provided the following article links for health professionals:
- MHRA drug safety update: Semaglutide (Wegovy, Ozempic and Rybelsus): risk of Non-arteritic Anterior Ischemic Optic Neuropathy (NAION) – external site
- EMA News: PRAC concludes eye condition NAION is a very rare side effect of semaglutide medicines Ozempic, Rybelsus and Wegovy – external site
- WHO News: The use of semaglutide medicines and risk of non-arteritic anterior ischemic optic neuropathy (NAION)
Suspected adverse events can be reported through the TGA’s adverse event reporting service.
OA members seeking advice about their professional responsibilities or the management of a particular situation can contact the Optometry Advisor Help Desk on 1800 678 662 or email OAhelpdesk@optometry.org.au.