{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T09:31:25Z","timestamp":1787391085609,"version":"build-2736575974"},"reference-count":7,"publisher":"BMJ","funder":[{"name":"the National Science and Technology Innovation 2030, Major Project \u2014 Research on Cancer, Cardiovascular, Respiratory and Metabolic Diseases","award":["2023ZD0508500"],"award-info":[{"award-number":["2023ZD0508500"]}]},{"name":"the National Science and Technology Innovation 2030, Major Project \u2014 Research on Cancer, Cardiovascular, Respiratory and Metabolic Diseases","award":["2023ZD0508504"],"award-info":[{"award-number":["2023ZD0508504"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,7,18]]},"abstract":"<jats:p>Semaglutide-associated non-arteritic anterior ischaemic optic neuropathy (NAION) mechanisms are unclear. We report a 28-year-old man with type 2 diabetes who developed right NAION 4\u20135 months after starting semaglutide. Multimodal imaging confirmed NAION and bilateral buried optic disc drusen. The affected eye was short, whereas the fellow eye was highly myopic and longer. Serial bioimpedance showed a 1.9\u2009L decline in total body water over 7 weeks, with preserved fat mass and stable extracellular-to-total-body-water (ECW\/TBW) ratio. We propose a hypothesis-generating \u2018two-hit\u2019 model in which anatomical susceptibility and sustained hypohydration together precipitate NAION. Heightened clinical awareness may be warranted and prospective studies are required.<\/jats:p>","DOI":"10.1136\/bjo-2026-329598","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:20:20Z","timestamp":1785777620000},"page":"bjo-2026-329598","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Semaglutide-associated NAION: a proposed \u2018two-hit\u2019 model involving buried optic disc drusen and sustained hypohydration"],"prefix":"10.1136","author":[{"given":"Guohong","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Tangdu Hospital Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Ma","sequence":"additional","affiliation":[{"name":"Ophthalmology, Tangdu Hospital Fourth Military Medical University, Xi\u2019an, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Tangdu Hospital Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aili","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Tangdu Hospital Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9373-502X","authenticated-orcid":false,"given":"Bin","family":"Gao","sequence":"additional","affiliation":[{"name":"Tangdu Hospital Fourth Military Medical University, Xi\u2019an, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"2026080310200901000_bjo-2026-329598v1.1","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1001\/jamaophthalmol.2024.2296","article-title":"Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide","volume":"142","author":"Hathaway","year":"2024","journal-title":"JAMA Ophthalmol"},{"key":"2026080310200901000_bjo-2026-329598v1.2","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1001\/jamaophthalmol.2025.2489","article-title":"Ocular Adverse Events With Semaglutide: A Systematic Review and Meta-Analysis","volume":"143","author":"Natividade","year":"2025","journal-title":"JAMA Ophthalmol"},{"key":"2026080310200901000_bjo-2026-329598v1.3","doi-asserted-by":"crossref","first-page":"100245","DOI":"10.1016\/j.apjo.2025.100245","article-title":"Does semaglutide increase the risk of non-arteritic anterior ischemic optic neuropathy? A systematic review and meta-analysis of emerging evidence","volume":"15","author":"Chen","year":"2026","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"2026080310200901000_bjo-2026-329598v1.4","doi-asserted-by":"crossref","first-page":"2512","DOI":"10.3390\/biomedicines12112512","article-title":"Methylglyoxal: A Key Factor for Diabetic Retinopathy and Its Effects on Retinal Damage","volume":"12","author":"Klochkov","year":"2024","journal-title":"Biomedicines"},{"key":"2026080310200901000_bjo-2026-329598v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.preteyeres.2024.101246"},{"key":"2026080310200901000_bjo-2026-329598v1.6","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2024.1416985","article-title":"Pharmacovigilance study of GLP-1 receptor agonists for metabolic and nutritional adverse events","volume":"15","author":"He","year":"2024","journal-title":"Front Pharmacol"},{"key":"2026080310200901000_bjo-2026-329598v1.7","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/WNO.0000000000000552","article-title":"Role of Nocturnal Arterial Hypotension in Nonarteritic Anterior Ischemic Optic Neuropathy","volume":"37","author":"Hayreh","year":"2017","journal-title":"J Neuroophthalmol"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2026-329598","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:20:21Z","timestamp":1785777621000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2026-329598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":7,"alternative-id":["10.1136\/bjo-2026-329598"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2026-329598","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]}}}