Reversable Bilateral Ischemic Optic Neuropathy Following Semaglutide Discontinuation with Crowded Optic Discs

Purpose To report the incidence of bilateral non-arteritic optic neuropathy (NA-AION) associated with unilateral branch retinal artery occlusion (BRAO) after using semaglutide and the resolution of NA-AION after the discontinuation of Semaglutide. Methods A retrospective case report. Results A 37-year-old obese male, who is not known to have systemic diseases, presented with a sudden drop of vision in the right eye and blurred vision in the left eye after 11 months of using semaglutide for 11 months. His best-corrected visual acuity (BCVA) was 6/200 in the right eye and 20/25 in the left eye. A relative afferent pupillary defect (rAPD) of 0.9 log units was observed in the right eye. Dilated fundus examination showed bilateral optic disc swelling, more significantly in the right eye, along with an inferior macular ischemia indicating BRAO. One month after semaglutide discontinuation, he presented with BCVA of 20/30 in the right eye and 20/20 in the left eye. Dilated fundus examination showed small optic nerve heads in both eyes with marked resolution of discs swelling in both eyes (Fig. 2 A and B). Conclusion This case highlights the importance of optic nerve assessments in addition to retinal examination prior to the initiation of GLP-1 RA treatments to minimize the risk of medication-related optic neuropathy.