Visual and Neurological Outcomes Following Glucagon-Like Peptide-1 Receptor Agonist Therapy and Bariatric Surgery in Idiopathic Intracranial Hypertension: A Network Meta-Analysis

Apr 13, 2026Metabolic syndrome and related disorders

Vision and nerve effects after weight-loss surgery and diabetes drug treatment in unexplained high brain pressure: A combined analysis

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Abstract

GLP-1 receptor agonists reduced body mass index by 1.55 kg/m compared to conventional therapy.

GLP-1 receptor agonists lowered the risk of papilledema by 53% compared to conventional therapy.
The risk of visual disturbance was reduced by 52% with GLP-1 receptor agonists.
A 22% reduction in headache risk was observed with GLP-1 receptor agonists compared to conventional treatment.
No significant differences were found between GLP-1 receptor agonists and bariatric surgery across studied outcomes.
Changes in papilledema severity and retinal nerve fiber layer thickness showed no significant differences.

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BACKGROUND: Idiopathic intracranial hypertension (IIH) is commonly linked to obesity. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and bariatric surgery may improve outcomes beyond conventional therapy, but comparative evidence is limited.

METHODS: We systematically searched MEDLINE, EMBASE, and Cochrane from inception until June 2025. Eligible randomized and observational studies compared GLP-1RAs or bariatric surgery (each plus conventional care) against conventional management. Primary outcomes were the change in papilledema, visual acuity, and visual field. Secondary outcomes included body mass index (BMI), retinal nerve fiber layer (RNFL) thickness, monthly headache days, and risks of papilledema, visual disturbance, and headache. Pairwise random-effects meta-analyses and frequentist network meta-analysis (-scores) were performed. P

RESULTS: Out of 429 records, 8 studies were included. Versus conventional therapy, GLP-1RAs reduced BMI (mean difference -1.55 kg/m; 95% confidence interval [CI]: -2.13 to -0.97) and lowered risks of papilledema (relative risk [RR]: 0.47; 95% CI: 0.34-0.65), visual disturbance (RR: 0.48; 95% CI: 0.24-0.98), and headache (RR: 0.78; 95% CI: 0.69-0.88). Changes in papilledema severity and RNFL thickness were not different; visual acuity favored GLP-1RAs at the end of follow-up, whereas visual field values were worse at some time points. In indirect comparisons with bariatric surgery, no significant differences were detected across outcomes. 2

CONCLUSIONS: Adjunctive GLP-1RA therapy may be associated with weight loss and improved clinical/ophthalmic outcomes in IIH relative to conventional care, with a signal for worse visual fields at certain time points. Indirect comparisons suggest comparable efficacy to bariatric surgery. High-quality randomized trials are needed to define comparative effectiveness, safety, and optimal use.

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Visual and Neurological Outcomes Following Glucagon-Like Peptide-1 Receptor Agonist Therapy and Bariatric Surgery in Idiopathic Intracranial Hypertension: A Network Meta-Analysis

Abstract

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