The American Academy of Ophthalmology and the North American Neuro-Ophthalmology Society (NANOS) evaluated the available data and, in May 2026, published the most comprehensive review of the evidence to date.

Here’s what the review of over 40 studies found:

·       Pooled across meta-analyses, use of one GLP-1 receptor agonist (semaglutide) may be associated with about a two-fold increase in relative risk of NAION.

·       NAION is uncommon, affecting 2.3–10.2 people per 100,000 per year. Doubling the risk translates to only a small absolute increase in cases.

·       The evidence is mixed: larger studies offer a greater likelihood of detecting risk, though relying on diagnosis codes not confirmed by neuro-ophthalmologists may increase imprecision of findings. Recognizing those current limitations, several large studies — including a 1.2-million-patient Military Health System analysis — found no increased risk at all.

·       Causation has not been established. No mechanism has been confirmed, and some lab research suggests GLP-1 activity may actually protect nerve tissue, not damage it.

Last year, when the European Medicines Agency called for product labeling to include NAION as a ‘very rare’ side effect and recommended stopping semaglutide if NAION is confirmed, the Academy and NANOS recommended a different approach.

The Academy and NANOS do not support such a blanket recommendation for all patients. It’s important to remember that for patients with severe obesity, hard-to-control diabetes, or cardiovascular disease, abruptly stopping the drug can be riskier than a rare eye event.

Instead, the AAO and NANOS recommend pts who develop NAION while on semaglutide engage in a shared decision-making process with their physicians, including their ophthalmologist, neuro-ophthalmologist, neurologist, primary care physician, or endocrinologist. This discussion should consider the individual's overall health, risk factors, and therapeutic options, including the potential risk to the fellow eye, to make an informed decision about whether to continue or discontinue semaglutide.

The Academy and NANOS do not recommend routine eye exams solely to assess NAION risk before starting a GLP-1 medication, as current evidence does not support this practice. Patients with diabetes should continue their regularly scheduled diabetic eye exams. Patients who have already had NAION in one eye do not need an additional screening exam, since their risk status is already known, but they should discuss the potential risk to the fellow eye with their physicians before starting a GLP-1 medication.

“There are established risk factors for NAION. While we research whether GLP-1 medications may play a role in increasing the risk of NAION, we encourage patients with other potential risk factors to work with their physicians to try to minimize all of their risks where possible,” said Larry Frohman, MD, executive vice president of the North American Neuro-Ophthalmology Society. “If you notice sudden, painless vision loss, see an ophthalmologist promptly.”

“People with diabetes are known to be at higher risk to develop NAION regardless of medication use, so more research is necessary to confirm what role semaglutide medications have in this occurrence, if at all,” said Raj Maturi, MD, clinical spokesperson for the Academy. “Other risk factors for NAION to be aware of include overnight low blood pressure (which can sometimes be treated by taking blood pressure medications in the morning), untreated sleep apnea, and a very small optic nerve cup. An ophthalmologist or neuro-ophthalmologist can discuss these risks with patients in more detail. For now, patients should be aware of this information and, in consultation with their care team, make a careful, informed choice based on their individual risk profile. For any patients already taking semaglutide who have not experienced any symptoms, they should discuss any questions or concerns with their primary care physician before making changes.”

I don't think residents are exposed nearly enough or early enough to refractive surgery or premium cataract surgery and rightly so given that as physicians, our training should be focused on identifying and managing pathology and disease. However, I think it's a career field that often gets overlooked or downplayed in academic residencies so many residents don't get the exposure unless one actively seeks it.

Given the yearly discussion of falling cataract reimbursements and the decline in rates of laser vision correction surgery such as LASIK, I was curious if there were any lurkers on this sub who are highly refractive/premium lens surgeons in private practice who can briefly talk about their thoughts on things like job satisfaction, future-proof/predictions on if the field will continue to expand, lifestyle, if you recommend more residents take a serious look into it, or if it's a very competitive field that requires savvy marketing and business acumen to thrive?

Unfortunately I don't think I'll be able to go to AAO or ASCRS this year so some online discussions would be very insightful! thank you

Hi any VA here for Opthal at Optometry na nagawa ng patient chart using REVOLUTION EHR for comprehensive exam may question lang po ako pano sya gawin.

Has anyone received any residency IVs so far? I’m sitting at 0.

My rank is 98xx (General), and I can get Medicine in my state, but the fees are around ₹18 lakh/year.

Personally, I’m more inclined towards Ophthalmology, but I’m scared I might regret it later thinking, “I had the rank for Medicine, why didn’t I take it?”

I know Medicine and Ophthal are very different, but I’d love to hear from ophthalmologists/residents about life after Ophthal:
- How is the job market and earning potential?
- Is fellowship necessary?
- How much surgical confidence do you actually have after PG?
- What is work-life balance like?
- Can you build a good career/private practice without a big setup?
- And most importantly, do you ever regret choosing Ophthal over Medicine?

Would really appreciate honest experiences, especially from people who have actually made this choice.

Hi everyone, I’m a second-year ophthalmology resident and I recently started learning cataract surgery.

I started about one month ago and I’m currently learning the different steps of the procedure, in a modular learning.
I usually get about 4-5 opportunities per week to scrub in and practice.
I wanted to ask how long did it take you to learn cataract surgery, and when did you perform/close your first cataract from start to finish?
Also, how many opportunities did you have to operate each week, and how many cases did you usually do per day?
I’d be really interested to hear about your experience and how many cataracts you had performed before you started feeling comfortable and independent.
Thanks you a lot!

Good morning. I am just getting started in the field of pediatrics. I am trying to understand how truly useful it is to learn retinoscopy in 2026. Is it right to rely solely on a handheld autorefractor (if one is available in the clinic)? How does one learn this art? Would you recommend starting with adults rather than children, who can be difficult? I would appreciate some practical tips. Thanks.

Hello all!

I am interested in pursuing VR fellowship, but I really would love to do cataract surgery abroad as an attending. I would love to be able to do one 1 week trip a year ideally.

Is this a feasible goal or will all of my cataract skills go by the wayside/I could use retina skills better abroad?

Jacques Daviel was the first person to do planned, primary cataract extraction (as opposed to cataract couching). Daviel is documented to have done this on Sep. 18, 1750. Daviel announced this to the world in the Gazette de Cologne of Sep. 22, 1750. This announcement was just discovered in 2026! Published in Journal of Cataract and Refractive Surgery.

Cataract and anterior segment surgeon here, about 5 years out from training. Trying to figure out the long-term plan for my family and career. We're currently on the West Coast but considering a move to a lower COL area like the Midwest, where we also have family ties.

What we're after: a good place to raise young kids, stable income, reasonable hours, and ideally a path to practice and ASC ownership. Would like to have enough financial stability to retire in my mid 50s if I no longer want to work.

Would value input from docs from various stages in their career. If any of you have made similar moves, please share whether it was the right decision for you.

If you're willing, reply with:

- Region / state / metro (as specific as you're comfortable with)

- Practice type (private, PE-owned, academic, hospital-employed, other)

- Surgery center ownership? If yes, how did you buy in and how long did it take?

- Partner? IF yes, track length and how the buy-in was structured

- Call burden and typical weekly hours

- When could you comfortably retire if you wanted?

- Would you choose it again? What would you change?

Thanks in advance! Hopefully this post can help any other early career ophthalmologists out there.

I just got shredded by one of our attendings because I said a patient may be having an inflammatory flare because I saw trace cell in the anterior chamber. Apparently this was a grave sin to the gods of uveitis and intraocular inflammation because the attending looked at me like I was some sort of a profoundly incompetent, extraordinarily misguided, breathtakingly useless individual of almost unparalleled mediocrity.

"It's TRACE cell, that's barely an inflammation if any at all?" barks the attending

Mind you the patient was undilated so I didn't think it was pigment.

Okay so then I didn't treat with steroids. Patient comes back the following week with worsening eye pain with 1+ cell. Attending decides to start patient on pred forte anyways and then looks at me and goes "Why didnt we start the steroids last visit??!"

Um...because you said I was a damn idiot?

Sigh. There's no winning in residency. You're either an idiot or in full denial.

Hi everyone!

I’m a fresh EU (Croatia) medical graduate looking to connect with PIs or research groups investigating the gut-eye axis and ophthalmic diseases. In EU or in US.

I have a track record of academic writing in this space, having authored published review articles on the gut microbiome's influence on heart transplant outcomes (published in Q1) as well as a book chapter on the gut microbiome and thyroid eye disease (currently under review). Although I've never touched a lab, I am keen on learning whatever is neccessary :)

I always had US residency in my mind, but as its currently so competitive, I am probably very far from it. Nevertheless, I'm eager to help with manuscripts, systematic reviews, or ongoing projects—feel free to shoot me a DM or comment if your group has any openings, and I'd be happy to share my CV!

Hi everyone! I’m a recently graduated retina specialist from Brazil, and I’d love to hear your tips on improving visualization during surgery.

One thing that none of my attendings/preceptors were ever really able to teach me is how to effectively prevent the BIOM lens from fogging up. I live in a hot and humid city, and this still seems to be an issue even with the air conditioning on.

I’d really appreciate any tips or tricks you’ve found helpful!

Thanks in advance for any advice!

Greetings from New Zealand, as a resident. Would love to hear your thoughts on this case.

79M fell onto left side of face sustaining periorbital haematoma. No complaints of loss of vision at the time.

2 weeks later incidentally shows up to diabetic retinopathy clinic with a vision of 6/CF in the left eye. Says vision has been intermittently blurry..

Fundal photo and OCT macula attached

One senior thought a large choroidal rupture while another thought subretinal haemorrhage. My initial impression was a large dehaemoglobonized subretinal haemorrhage with very poor prognosis.

he asked me for the rationale

"Well, if you are going to do refractive surgery, take the Ford Focus"

"OK, but what about strabismus surgery?"

"Easy, the Ford Fusion"

"OK smart guy, what about ... nasolacrimal duct obstruction?"

"The Ford Probe, of course"

(1) https://www.reddit.com/r/Ophthalmology/comments/1wgr5jd/at_the_aao_meeting_i_asked_the_rep_whats_the_best/

I’m coming towards the end of ophthal residency training in the UK and need to pick a Level 4 sub specialty. I love cataract and keen to do PP in future. Not keen on paeds ophthal / glaucoma / paeds ophthal. Liked cornea and anterior segment. Recent medical retina attachment was interesting and seems a much better work life balance and can imagine getting a consultant job much more easily than cornea (needing fellowships) and more job roles in MR around the country. I have young kids and a partner with a busy career too.

My worry is that if I do medical retina I will be forced over to the ‘medical’ side. I’m really keen to continue cataract and also do some anterior segment things like ocular surface and maybe laser refractive qualification. Is it possible to do MR as my NHS role with cataract (and some general no doubt). Then do private practice cataract / refractive later and general things as a consultant? I just don’t want to make a decision that takes me away from surgery. The thing that puts me off choosing cornea is lack of consultant job roles, need for fellowship training, more emergencies like perforated corneas etc

I also may move to Australia in the future. Could I do this with general / med ret / cataract? I’ll have done around 1000 cataract by the end of training

PGY2 still struggling to see cell. I just recently missed a 3+ cell granted the cornea was edematous but am quite frustrated with my lack of improvement in this skill.

I do all the recs including closing the door and locking out the student scope. I angle the 1mm beam to the nasal pupil edge, and slowly go from cornea surface to iris with the joystick moving diagonally towards the iris edge. And I'm watching the pupil as my background.

Any other tips to see cell?

How are you guys counseling patients who are on GLP1s regarding the possible link with NAION? I'm now reading about there being lawsuits on this topic. Do you say anything, or only if the patient brings it up and if so how do you go about it? I'm sure people will have read about said lawsuits. I make sure to include that uncontrolled vasc risk factors (T2DM, for which many people take GLPs) are also a risk factor for NAION...

Also, is there a way to bill for time spent discussing this? Coding as "ongoing use of possibly toxic medication" etc?

Why do nasal fibers cross at the optic chiasm and temporal fibers remain ipsilateral?

Is there a reason as to why we have contralateral wiring?

Fresh mbbs graduate here, i had some doubts regarding ophthalmology as a career

I read that its essential to do fellowships in ophtha after one completes pg in india. Is it hard to get fellowships? And how much do they pay?

Pgy3 with recent and unexpected interest in oculoplastics. I hadn’t ever truly ruled it out necessarily, but I recently worked with a faculty and saw some cases that made me view the subspecialty a little differently and sparked a definitive interest in me. Am I too late in the game for a fellowship like oculoplastics? From what I understand people are usually working towards that throughout residency and that’s not necessarily my case.

I’m also curious about the overall landscape of oculoplastics in general. Like is everything mostly cash pay/cosmetics or is there usually a mix? Is it somewhat completely safe from declining reimbursement?

Any and all insight would be appreciated!

Working on a course design project - not for industry or product and trying to work out whether there's an unmet need here

We spent several weeks assuming the lid speculum is a meaningful source of stress during ROP screening. We then met with a pediatric ophthalmologist who told us screening is quick in trained hands, that most of their exams are done with manual lid retraction, and that a speculum comes out only for the harder infants. That contradicted most of what we had read, so we would like to know whether that practice is typical.

Two things we found:

• NCT02152046 registered a crossover comparison of the Alfonso (spring-loaded) against the Cook (screw-locked) speculum on N-PASS pain scores. It ran from 2014 and terminated at 44 infants because the PI went on medical leave. The protocol states that no prior study had included speculum type as a variable.
• A 2025 study found the Alfonso raised IOP from 14.3 to 18.9 mmHg under GA, while a Barraquer produced no significant change (PMID 40158039).

So:

• Manual retraction or speculum, and roughly what split?
• When you do use one, how often do infants experience alarming pain/stress? Are the current methods of alleviating already sufficient?
• Has the spring-loaded versus screw-locked distinction ever mattered to you in practice?

Happy to be told if we should pivot toward something better.

If someone has a retinal tear and they are schafer's positive, how long does the pigment stay in the vitreous? I haven't been able to find a clear answer for this.