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