Semaglutide-inducing Non-arteritic Anterior Ischemic Optic Neuropathy and Ipsilateral Blindness -A Rare Presentation

Background: Semaglutide, a glucagon-like peptide-1 receptor agonist, was approved by the FDA in 2017. It is commonly prescribed as an adjunct regimen or alternative monotherapy for patients with type 2 diabetes who have failed initial treatment with metformin and lifestyle modification. Semaglutide is well known for its benefits in blood glucose control, weight loss, and reducing the risk of major atherosclerotic cardiovascular disease (ASCVD), including stroke and heart attack. It has been increasingly prescribed in cardiology offices to control risk factors for ASCVD. A recent cohort study showed an association between semaglutide use and the development of non-arteritic anterior ischemic optic neuropathy. Case presentation: A 63-year-old male patient presented to his cardiologist’s office for a hospital follow-up after a sudden onset of right lower visual field loss due to optic nerve edema. It was a sudden onset of lower visual field loss in the right eye, progressing upward with pain over his right temporal area after taking semaglutide for one year. In the hospital, a CT head, MRI of the orbit, carotid ultrasound, echocardiogram, and temporal artery biopsy were all negative for any ischemic, embolic, or inflammatory processes. The patient’s negative workup during admission suggested a possible diagnosis of exclusion: semaglutide-associated optic neuropathy. Conclusion: This case highlights a rare but potentially serious adverse effect of semaglutide. Physicians should be aware of the possibility of iatrogenic optic edema, sudden vision loss, and early signs of such side effects secondary to semaglutide use. Education should be provided to every patient taking semaglutide.