Semaglutide and NAION: Recording GLP-1 Use in Eye Care EHRs
European and UK regulators list NAION, a sudden loss of blood flow to the optic nerve, as a very rare semaglutide side effect, in up to 1 in 10,000 users. Charts often miss GLP-1 use from telehealth or cash-pay prescriptions, so ask by name at intake, record it as a structured medication, and triage sudden vision loss the same day.
Step-by-step
- Add GLP-1 questions to intake — Ask by name whether the patient takes Ozempic, Wegovy, Rybelsus, Mounjaro or Zepbound, who prescribed it and when they started. Your intake now catches drugs patients forget to list.
- Record the drug as a structured medication — During medication reconciliation, enter the drug in the EHR medication list coded to its ingredient, not in a free-text note, so it can be searched and reported.
- Reconcile imported medication lists — Where your EHR can import a primary care medication list through C-CDA or a health information exchange, compare it with the patient's answers at every visit.
- Give the front desk a vision-loss script — Write a script that routes any report of sudden vision loss to a same-day assessment or emergency care, and test that your after-hours service follows it.
- Set a chart flag and a monthly report — Create an alert for active semaglutide or tirzepatide and a monthly list of these patients by last exam date, so your doctors can decide on follow-up and recall.
- Update referral and education templates — Add drug, dose, start date and prescriber to your referral letter, include adverse-event reporting links, and store a short patient handout in the EHR.
On this page
- What Regulators and Researchers Have Said
- Where the US labels stand
- Why GLP-1 Use Is Missing From Eye Care Charts
- Change the Intake Form and Medication Reconciliation
- Triage Sudden Vision Loss the Same Day
- Flags, Reports and Recall
- Documentation, Referral Letters and Patient Education
- Our Recommendation
- Sources
If a patient takes semaglutide, your chart should record it in a field you can search. In June 2025 the European Medicines Agency's safety committee concluded that non-arteritic anterior ischemic optic neuropathy (NAION), a sudden loss of blood flow to the optic nerve, is a very rare side effect of semaglutide, the active ingredient in Ozempic, Wegovy and Rybelsus. Many eye care charts still miss these drugs. This guide covers the intake, triage, recall and reporting changes that close the gap.
This is a guide to practice workflow and records, not medical advice. Decisions about NAION, GLP-1 drugs and referral belong to your doctors; follow your clinical guidelines and local protocols.
What Regulators and Researchers Have Said
The EMA's Pharmacovigilance Risk Assessment Committee (PRAC) announced on 6 June 2025 that NAION may affect up to 1 in 10,000 people taking semaglutide. It relied on large studies of adults with type 2 diabetes that found roughly double the risk compared with people not taking the drug. In absolute terms, the EMA put that at about one extra case per 10,000 person-years of treatment. It recommended adding NAION to the product information as a very rare side effect.
In the UK, the MHRA's Drug Safety Update of 5 February 2026 told clinicians to refer patients with sudden vision loss, including partial loss, urgently for specialist eye assessment. It also warned that privately prescribed semaglutide may not appear in a patient's medical history, so clinicians should ask about it directly. The MHRA had received three UK Yellow Card reports of NAION with semaglutide up to 1 August 2025, against an estimated 10.2 million packs dispensed over five years.
A study in JAMA Ophthalmology, published online on 12 February 2026, followed US veterans with type 2 diabetes. NAION occurred at 123 per 100,000 person-years in those who started semaglutide and 67 per 100,000 in those who started an SGLT2 inhibitor, a different class of diabetes drug. The weighted risk was about 2.3 times higher, yet the cumulative incidence over a median 2.1 years was 0.29% against 0.13%. The authors described the absolute risk as low.
Where the US labels stand
As of 3 October 2026, the US prescribing information on DailyMed for Ozempic (June 2026 version), Wegovy (June 2026) and Rybelsus (January 2026) contained no NAION wording. Each warns about diabetic retinopathy complications instead. For tirzepatide we found no regulator conclusion on NAION: the Mounjaro label (August 2026) does not mention it, and the MHRA says it is reviewing evidence for other GLP-1 agonists. A missing label warning is not proof of safety. It does mean a US patient may never have been told about the risk.
Why GLP-1 Use Is Missing From Eye Care Charts
Most eye care medication lists are built from what the patient remembers on the intake form. GLP-1 drugs slip past that in four common ways.
- Weight-loss framing. A patient taking Wegovy for weight may not think of it as a medicine worth telling an eye doctor about.
- Cash-pay and telehealth prescriptions. A prescription from an online weight-loss service or a private clinic may never reach the primary care record, which is the gap the MHRA describes.
- Compounded products. A patient may know the drug only by a clinic's name for it or as "my weekly shot", not as semaglutide or tirzepatide.
- Free-text entries. "Ozempic", "ozempik" and "weekly diabetes injection" typed into a notes box cannot be searched or reported reliably.
Change the Intake Form and Medication Reconciliation
Ask about these drugs by name. A general "list your medications" prompt misses them; a specific question catches them. Add these to your intake form or portal questionnaire:
- Do you take, or have you taken in the last year, a weekly injection or daily tablet for diabetes or weight loss, such as Ozempic, Wegovy, Rybelsus, Mounjaro or Zepbound?
- Who prescribed it: your regular doctor, an online service, a weight-loss clinic or a compounding pharmacy?
- When did you start, and has the dose changed recently?
- Have you noticed any sudden change in vision in either eye since you started?
At check-in, a technician confirms the answers during medication reconciliation and records the drug in the EHR's structured medication list, not in a free-text note. A structured entry coded to the drug ingredient is what lets you search, alert and report later. If your EHR only supports free text, standardise the spelling and ask your vendor when structured medications will be available.
Interoperability helps too. If your system can import the medication list from the patient's primary care physician through a C-CDA summary or a health information exchange, reconcile it at every visit. Our guide to connecting your optometry EHR with medical systems explains which standards to ask your vendor about. An imported list can still miss private prescriptions, so keep asking the intake questions.
Triage Sudden Vision Loss the Same Day
Sudden vision loss is urgent whatever the cause, and NAION is only one of them. Give the front desk a written script and use the same one for phone calls, texts and online booking requests:
- Ask whether the change came on suddenly, within the last few days, in one or both eyes. Any yes means the request is not booked as routine.
- Transfer the caller to the on-duty doctor, or follow your practice's urgent protocol for a same-day assessment.
- If no clinician is available, direct the patient to emergency care, as the MHRA advises patients to do.
- Record the call, the advice given and any GLP-1 use the patient mentions in the chart.
If an AI receptionist or answering service takes calls after hours, test that it escalates "sudden vision loss" instead of offering the next routine slot. Our checklist for choosing an AI receptionist for an eye care practice covers the red-flag escalation rules to confirm before go-live.
Flags, Reports and Recall
Once GLP-1 drugs sit in structured fields, three things become possible.
- A chart flag. Set an alert that appears when a patient's active medications include semaglutide or tirzepatide, so the doctor sees it before the exam. Keep the flag factual, such as "on semaglutide since March 2026", not diagnostic.
- A report. Pull a monthly list of active patients with a GLP-1 drug on their medication list, sorted by last exam date. Search by drug ingredient rather than brand, and include compounded entries by name.
- Recall. Your doctors decide which patients need closer follow-up, and the recall system schedules it. Diabetic patients on a GLP-1 drug already need an annual diabetic eye exam; our guide to AI screening tools for diabetic eye exams shows how to build that program, and our comparison of patient recall systems for optometry covers the software that sends the reminders.
Documentation, Referral Letters and Patient Education
When a doctor suspects NAION, the referral letter should state the drug, dose, start date and prescriber next to the visual findings. Both the EMA and the MHRA say semaglutide should be stopped if NAION is confirmed, so the receiving clinician and the prescriber need that history. Send a copy to the prescriber, even when it is a telehealth service, and record in the chart that you did.
Suspected side effects can be reported through the MHRA's Yellow Card scheme in the UK and the FDA's MedWatch program in the US. Add the link to your referral template so nobody has to look it up.
For patient education, keep the message balanced. A short handout can say that the risk is very rare, that sudden vision loss should be reported to an eye doctor the same day, and that any change to a prescribed medicine should be agreed with the prescriber. Store the handout in the EHR so you can record that each patient received it.
Our Recommendation
Start with the intake question and the front-desk script, because they cost nothing and protect patients this week. Then move GLP-1 drugs into structured medication fields so you can flag, report and recall. If your EHR cannot do that, raise it at your next vendor review. Next, read our guide to EHR interoperability for optometrists to see how imported medication lists fill the gaps that patients leave.
Sources
- EMA, 6 June 2025: PRAC concludes NAION is a very rare side effect of semaglutide
- MHRA Drug Safety Update, 5 February 2026: Semaglutide and risk of NAION
- Heberer K, et al. New-Onset NAION and Initiators of Semaglutide in US Veterans With Type 2 Diabetes. JAMA Ophthalmology, 2026
- DailyMed: Ozempic prescribing information
- DailyMed: Wegovy prescribing information
- DailyMed: Mounjaro prescribing information
