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01.
arXiv (CS.CV) 2026-06-12

Budget-Constrained Step-Level Diffusion Caching

Step-level caching accelerates diffusion models by exploiting temporal redundancy across denoising steps. Existing methods make per-step cache decisions using threshold-based heuristics, without directly optimizing for final output quality. As a result, their inference latency varies across inputs and is difficult to control at deployment. In this work, we propose BudCache, which inverts this formulation: rather than letting per-step error thresholds dictate the runtime cost, we fix the compute budget in advance and search for the cache policy that best preserves the final output. To tackle the combinatorial complexity of step selection, we combine Simulated Annealing with deterministic Hill Climbing. This offline search identifies high-quality cache policies within minutes and introduces no online search or thresholding overhead during inference. When the compute budget is very tight, we further introduce cache-aware schedule alignment, which adapts the time discretization to the selected cache policy to reduce cache-induced trajectory mismatch. Experiments on FLUX.1-dev and Wan2.1 show that BudCache achieves better generation quality than heuristic caching baselines under the same inference budgets. Code is available at https://github.com/Westlake-AGI-Lab/BudCache

02.
arXiv (CS.CL) 2026-06-11

Cross-modal Consistency Guidance for Robust Emotion Control in Auto-Regressive TTS Models

While Text-to-Speech (TTS) systems enable emotional control via natural-language instructions, expressiveness, naturalness, and speech quality degrade when the target emotion conflicts with the textual semantics. We propose a Cross-modal Consistency Guided Classifier-Free Guidance (CCG-CFG) method with dynamic scales based on the degree of inconsistency between the text emotion and the explicit speech emotion, replacing the dropout condition with the text emotion. We also distill the CCG-CFG guidance signal using a hard-sample mining strategy, improving the TTS model's emotional alignment capability. Evaluations on five emotional corpora and two TTS benchmarks show that our approaches applied to CosyVoice2 achieve up to a 12% absolute improvement in emotion-recognition accuracy and a 10% relative improvement in subjective scores, outperforming baselines including HierSpeech++, Qwen3-TTS, and original CosyVoice2, while preserving intelligibility, naturalness, and high speech quality.

03.
bioRxiv (Bioinfo) 2026-06-17

Correcting spatial transcriptomics data affected by a prevalent transcript leakage problem across platforms, species, and tissues

Spatial transcriptomics has been widely applied to study the spatial distribution of cell types, cell states, and specific gene expression in tissue samples. However, we show that there is a prevalent transcript leakage problem in spatial transcriptomics data, where transcripts expressed by a cell diffuse to its neighborhood and are recurrently detected in the nearby cells. By analyzing published data sets, we show that this problem is general across data produced from different tissues and different species using different imaging-based and sequencing-based spatial transcriptomics platforms. It affects both upstream tasks such as expression quantification as well as downstream tasks such as cell-type annotation and detection of spatially-dependent gene expression. To tackle the transcript leakage problem, we propose a reference-free Bayesian model-based method, DeLeakage, which cleans up the data much more effectively than existing denoising methods. DeLeakage also improves cell-type annotation and avoids false detection of spatially dependent expression.

04.
bioRxiv (Bioinfo) 2026-06-15

SMS: Symmetric Mediation Statistics for Powerful High-Dimensional Mediation Analysis

Background: Mediation analysis of high-dimensional features, particularly molecular-level omics features, provides important opportunities to uncover biological mechanisms underlying human health and disease. However, two central statistical challenges remain: testing the composite-null hypothesis and maintaining power when the exposure-mediator and mediator-outcome associations differ substantially in statistical significance. Existing methods typically rely on accurate estimation of the proportions of the three null types or on the maximum of the two association p-values, and may not always control the FDR well and may have limited power under imbalanced significance. Methods: We propose SMS, a new statistical framework based on symmetric mediation statistics. By exploiting symmetry, SMS calibrates the composite null distribution as a whole for FDR control. It also allows flexible combinations of the two association p-values, including the maximum, and then enables construction of an omnibus test. Moreover, it permits direct use of effect-size estimates, bypassing the need to compute p-values. Results: SMS controlled the FDR across a wide range of simulation scenarios while achieving a substantial sensitivity gain, often around 20 percentage points, over existing methods including HDMT, DACT, and DEI-B. Applications to a metabolomics dataset and a DNA methylation dataset further corroborated these findings. Notably, SMS discovered five plausible mediators in the metabolomics dataset that were missed by all existing methods considered.

05.
arXiv (CS.AI) 2026-06-19

Exit-and-Join Dynamics for Decentralized Coalition Formation

作者:

arXiv:2606.19683v1 Announce Type: new Abstract: This paper studies coalition formation as a decentralized dynamical process driven by unilateral exit-and-join decisions. Agents evaluate local moves using the Aumann-Dreze value, so payoffs are computed within the agent's current coalition rather than through a globally negotiated coalition structure. The resulting model links cooperative payoff allocation with noncooperative best-response behavior: a terminal partition is precisely a coalition structure with no admissible, individually profitable exit-and-join deviation. We establish equilibrium characterizations, identify conditions under which the dynamics admit scalar Lyapunov or exact-potential representations, and analyze how switching and acceptance costs shape local stability. Numerical experiments test finite-time stabilization, cost sensitivity, and a special convex-game benchmark.

06.
arXiv (CS.LG) 2026-06-16

CacheMuon: Using Temporal Preconditioning To Approximate Polar Factor

arXiv:2606.16371v1 Announce Type: new Abstract: Muon is an optimizer that computes updates using the polar factor of the momentum matrix and has shown strong empirical performance across a range of training settings. A key component of Muon is the Newton-Schulz iteration used to compute this polar factor. Although this avoids the cost of an exact singular value decomposition, it remains expensive in practice because it is applied at every optimization step. At the same time, the momentum matrix changes smoothly over training, suggesting strong temporal correlation in the corresponding polar factors. In this paper, we exploit this structure and propose CacheMuon, a temporal preconditioning method that reuses information from previous optimization steps to approximate the polar factor at the current step. This reduces redundant orthogonalization computation across iterations. We analyze CacheMuon as an inexact Muon update, with error controlled by fresh-solver error and cache staleness. Empirically, CacheMuon provides a controllable quality-efficiency frontier: conservative thresholds closely match fresh Muon on language-model and vision training while reducing orthogonalization FLOPs, whereas more aggressive thresholds yield larger arithmetic savings at the cost of modest validation-quality degradation.

07.
arXiv (CS.AI) 2026-06-11

Making Models Unmergeable via Scaling-Sensitive Loss Landscape

arXiv:2601.21898v2 Announce Type: replace Abstract: The rise of model hubs has made it easier to access reusable model components, making model merging a practical tool for combining capabilities. Yet, this modularity also creates a governance gap: downstream users can recompose released weights into unauthorized mixtures that bypass safety alignment or licensing terms. Because existing defenses are largely post-hoc and architecture-specific, they provide inconsistent protection across diverse architectures and release formats in practice. To close this gap, we propose Trap$^2$, an architecture-agnostic protection framework that encodes protection into updates during fine-tuning, regardless of whether they are released as adapters or full models. Instead of relying on architecture-dependent approaches, Trap$^2$ uses weight re-scaling as a simple proxy for the merging process. It keeps released weights effective in standalone use, but degrades them under re-scaling that often arises in merging, undermining unauthorized recomposition.

08.
arXiv (quant-ph) 2026-06-11

TensorKit.jl: A Julia package for large-scale tensor computations, with a hint of category theory

arXiv:2508.10076v2 Announce Type: replace-cross Abstract: TensorKit$.$jl is a Julia-based software package for tensor computations, especially focusing on tensors with internal symmetries. This paper introduces the design philosophy, core functionalities, and distinctive features, including how to handle abelian, non-abelian, and anyonic symmetries through the ``TensorMap'' type. We highlight the software's flexibility, performance, and its capability to extend to new tensor types and symmetries, illustrating its practical applications through select case studies.

09.
medRxiv (Medicine) 2026-06-17

Wearable-Grade Lead Reduction Disproportionately Degrades ECG AI Performance in Elderly Patients: Evidence from PTB-XL and MIT-BIH

Consumer wearable devices increasingly use single-lead electrocardiograms (ECGs) for cardiac monitoring, but these signals contain substantially less spatial information than the clinical 12-lead standard. Whether this reduction dispro- portionately affects older adults, who often present with more complex cardiac conditions, remains poorly understood. In this study, we evaluated the impact of lead reduction on AI-ECG diagnostic performance across age groups. A 1D resid- ual neural network was trained on 21,091 PTB-XL ECG recordings spanning five diagnostic superclasses and assessed using 12-, 6-, 2-, and 1-lead configurations. Under the full 12-lead setting, model accuracy declined from 84.5% in patients younger than 40 years to 66.2% in patients aged 75 years or older. Progressive lead reduction further widened this gap. Under the 1-lead configuration, accuracy decreased by 14.1 percentage points in the 75+ group but by only 0.4 percent- age points in the

10.
arXiv (CS.CL) 2026-06-11

I Understand How You Feel: Enhancing Deeper Emotional Support Through Multilingual Emotional Validation in Dialogue System

Emotional validation - explicitly acknowledging that a user's feelings make sense - has proven therapeutic value but has received little computational attention. Emotional validation in dialogue systems can be decomposed into (i) validating response identification, (ii) validation timing detection, and (iii) validating response generation. To support research on all three subtasks, we release M-EDESConv, a 120k English-Japanese multilingual corpus created through hybrid manual and automatic annotation, and M-TESC, a multilingual spoken-dialogue test set. For timing detection, we propose MEGUMI, a Multilingual Emotion-aware Gated Unit for Mutual Integration, that fuses frozen XLM-RoBERTa semantics with language-specific emotion encoders via cross-modal attention and gated fusion. MEGUMI shows superior performance on both the M-EDESConv and M-TESC datasets, both objectively and subjectively. Finally, our EmoValidBench benchmarks of GPT-4.1 Nano and Llama-3.1 8B indicate that current LLMs generate contextually similar and diverse validating responses, but emotional understanding remains a major area for improvement. Project page: https://github.com/zihaurpang/Multilingual-Emotional-Validation

11.
arXiv (CS.CL) 2026-06-16

Beyond Monolingual Deep Research: Evaluating Agents and Retrievers with Cross-Lingual BrowseComp-Plus

Deep research agents are increasingly evaluated on their ability to search for evidence, reason over retrieved sources, and produce grounded answers. Existing browsing benchmarks, however, largely assume that the user's query and the supporting evidence are written in the same language, leaving open whether agentic search systems can operate when relevant evidence appears in another language. We introduce XBCP (Cross-lingual BrowseComp-Plus), a controlled benchmark that preserves the English question-and-answer space of BrowseComp-Plus but varies the languages of the supporting documents. XBCP instantiates two complementary settings: in the cross-lingual setting, each query is paired with evidence in a single assigned language. In the multilingual setting, the full evidence corpus is distributed equally and randomly across 12 languages spanning high-resource and low-resource regimes. We evaluate four deep research agents using sparse and dense multilingual retrievers, measuring answer accuracy, evidence recall, search behavior, calibration, citation fidelity, and oracle retrieval. Results reveal substantial degradation when evidence is translated. Even strong, dense retrievers lose evidence recall, and agents become less calibrated and cite evidence less reliably. Notably, accuracy remains lower even when all gold evidence is supplied directly. These findings suggest that cross-lingual deep research exposes both retrieval failures and an independent, agent-side difficulty in integrating language-mismatched evidence.

12.
arXiv (quant-ph) 2026-06-15

Efimov Effect in Ultracold Microwave-Shielded Polar Molecules

arXiv:2602.21433v2 Announce Type: replace-cross Abstract: A quantum-mechanical description is presented for the three-body physics of shielded dipolar molecules, including a prediction of observable Efimov physics. Despite the anisotropic and long-range nature of the interaction, shielding enables a regime in which universality emerges already at the two-body level and extends to the three-body sector, where Efimov physics emerges. On the negative side of the scattering-length resonance, computed trimer binding energies display the characteristic scaling expected for Efimov resonances. Finally, the sudden approximation can be used to create trimer bound states, starting from positive energy trap states as a way to create or detect these molecular trimers. Moreover, the three-body parameter expressed in dipolar units is found to be universal.

13.
arXiv (CS.AI) 2026-06-18

Detecting High-Potential SMEs with Heterogeneous Graph Neural Networks

arXiv:2602.19591v3 Announce Type: replace-cross Abstract: Small and Medium Enterprises (SMEs) constitute 99.9% of U.S. businesses and generate 44% of economic activity, yet systematically identifying high-potential SMEs remains an open challenge. We introduce SME-HGT, a Heterogeneous Graph Transformer framework that predicts which SBIR Phase I awardees will advance to Phase II funding using exclusively public data. We construct a heterogeneous graph with 32,268 company nodes, 124 research topic nodes, and 13 government agency nodes connected by approximately 99,000 edges across three semantic relation types. SME-HGT achieves an AUPRC of 0.621 0.003 on a temporally-split test set, outperforming an MLP baseline (0.590 0.002) and R-GCN (0.608 0.013) across five random seeds. At a screening depth of 100 companies, SME-HGT attains 89.6% precision with a 2.14 lift over random selection. Our temporal evaluation protocol prevents information leakage, and our reliance on public data ensures reproducibility. These results demonstrate that relational structure among firms, research topics, and funding agencies provides meaningful signal for SME potential assessment, with implications for policymakers and early-stage investors.

14.
arXiv (CS.LG) 2026-06-16

A Gradient Perspective on RLVR Stability and Winner Advantage Policy Optimization

arXiv:2606.16154v1 Announce Type: new Abstract: Reinforcement learning with verifiable rewards (RLVR) improves language-model reasoning, but GRPO-style optimization remains prone to collapse. We analyse this instability through token-level gradient dynamics, deriving a taxonomy that predicts how updates affect next-token probabilities and entropy. The taxonomy shows that stability depends jointly on the advantage sign and token distribution under the current policy. Motivated by this finding, we propose Winner Advantage Policy Optimization (WAPO), a simple online clipped policy-gradient objective that updates only on positive-advantage completions. Across mathematical reasoning and multi-hop QA benchmarks, WAPO improves training stability and matches or outperforms baselines across multiple model families. Full code can be found at https://github.com/layer6ai-labs/wapo.

15.
bioRxiv (Bioinfo) 2026-06-16

PhenoBIC: operator-free single-cell spatial phenotyping in multiplex imaging data using deep learning of cell staining patterns

Multiplex imaging is a valuable tool for spatially examining tissue microenvironments at the single-cell level to uncover biological and clinical insights. However, most multiplex image analysis workflows currently require manual intervention for cell phenotyping, which slows progress, demands human effort, and yields operator-dependent outputs. Here, we developed PhenoBIC, a pre-trained deep learning model for image classification of the multiplexed biomarker signals in a cell (Biomarker Imprint of a Cell) to classify cell phenotypes. We show that PhenoBIC (F1-score ~0.88) outperforms manual gating (widely used) and other machine learning-based computational approaches for cell marker expression classification. We validated this across multiple biomarkers, tissue sampling strategies (whole biopsies and tissue microarrays), multiplex panels, imaging platforms, and tissue types. We have released our in-house training and validation datasets of ~1.4 million manually curated cell expression ground truth labels. We have also open-sourced PhenoBIC and enabled its community-wide deployment via the QuPath interface.

16.
arXiv (CS.LG) 2026-06-18

Geometric and Stochastic Analysis of Discontinuities in Sparse Mixture-of-Experts

arXiv:2606.19036v1 Announce Type: new Abstract: Sparse Mixture-of-Experts (SMoE) architectures are now widely deployed in state-of-the-art language and vision models, where conditional routing allows scaling to very large networks. However, this very Top-$k$ expert selection that enables conditional routing also renders the SMoE map inherently discontinuous. In the vicinity of these discontinuity surfaces, even inputs that are arbitrarily close may activate substantially different sets of experts resulting in significantly different outputs. In this work we give a rigorous geometric and stochastic analysis of these discontinuities. We first classify them by order, determined by the number of tied experts at a switching event. Using measure-theoretic slicing arguments, we establish asymptotic volume estimates for the thickened discontinuity surfaces, showing that lower-order discontinuity sets dominate, whereas higher-order ones occupy a vanishingly small relative volume. Next, modeling random perturbations in the input space via a diffusion process, we prove that the path eventually encounter a discontinuity, and moreover that the first hit almost surely occurs on an order-1 discontinuity with explicit finite-time probability bounds. We further derive occupation-time bounds that quantify the duration the random path spend in the neighborhoods of each discontinuity order. These theoretical results imply that inputs are more likely to lie near lower order discontinuities. Motivated by this insight, we propose a simple smoothing mechanism that can be directly applied to existing SMoEs, softly incorporating experts near discontinuities; our analysis guarantees that the added computational overhead remains small while providing localized smoothing near discontinuities, and experiments across language and vision tasks show that smoothing not only enforces continuity of the SMoE map but also enhances empirical performance.

17.
PLOS Medicine 2026-05-26

Requiring code sharing to strengthen transparency and trust in research

by Helen Lumbard, Lauren Cadwallader, Devin Soper, on behalf of the PLOS Medicine Staff Editors PLOS Medicine has always championed open science and data transparency. Now, recognizing that code is as essential a research artifact as the data it analyzes, we are strengthening our code sharing policy to further ensure reproducibility and trust in the scientific record. Recognizing that code is as essential a research artifact as the data it analyzes, this Editorial outlines how PLOS Medicine is strengthening its code sharing policy to further ensure reproducibility and trust in the scientific record.

18.
arXiv (CS.CV) 2026-06-11

DeceptionX: Explainable Deception Detection with Multimodal Large Language Models

Deception detection is a critical and highly challenging task within affective computing and behavioral analysis. Existing deep learning methods typically treat this task as a straightforward classification problem; however, this black-box approach lacks interpretability and fails to capture the complex logical deduction processes utilized by human experts when identifying lies. While Multimodal Large Language Models (MLLMs) have shown potential, applying them effectively requires a bridge between low-level audiovisual cues and high-level logical reasoning. In this paper, we propose DeceptionX, a novel MLLM framework that shifts the paradigm of deception detection from black-box classification to an interpretable Observe-Think-Summarize reasoning process. To address the scarcity of high-quality reasoning data, we first constructed DeceptChain, a high-quality dataset developed through a human-in-the-loop process. This dataset synthesizes fine-grained visual and auditory evidence (such as micro-expressions and vocal tremors) into structured chain-of-thought reasoning data. Furthermore, we propose a three-stage training pipeline and a Discrepancy-Aware Redundancy Elimination~(DARE) strategy for DeceptionX to further enhance the model's generalization capabilities. Extensive experiments demonstrate that DeceptionX not only outperforms existing MLLM baselines and state-of-the-art methods on standard real-world benchmarks but also provides transparent, expert-level reasoning paths, bridging the critical gap between accuracy and interpretability in multimodal deception detection.

19.
arXiv (CS.CL) 2026-06-15

Large Language Model Agents Are Not Always Faithful Self-Evolvers

Self-evolving large language model (LLM) agents continually improve by accumulating and reusing past experience, yet it remains unclear whether they faithfully rely on that experience to guide their behavior. We present the first systematic investigation of experience faithfulness, the causal dependence of an agent's decisions on the experience it is given, in self-evolving LLM agents. Using controlled causal interventions on both raw and condensed forms of experience, we comprehensively evaluate four representative frameworks across 13 LLM backbones and 9 environments. Our analysis uncovers a striking asymmetry: while agents consistently depend on raw experience, they often disregard or misinterpret condensed experience, even when it is the only experience provided. This gap persists across single- and multi-agent configurations and across backbone scales. We trace its underlying causes to three factors: the semantic limitations of condensed content, internal processing biases that suppress experience, and task regimes where pretrained priors already suffice. These findings challenge prevailing assumptions about self-evolving methods and underscore the need for more faithful and reliable approaches to experience integration.

20.
arXiv (CS.CL) 2026-06-15

TVIR: Building Deep Research Agents Towards Text-Visual Interleaved Report Generation

Deep Research Agents have shown strong capability in multi-step information retrieval, reasoning, and long-form report generation, but existing benchmarks and systems remain predominantly text-centric, with limited evaluation of whether visual elements are factually reliable and well aligned with the surrounding analysis. To address this gap, we introduce TVIR (Text-Visual Interleaved Report Generation), which includes TVIR-Bench, a benchmark of 100 expert-curated multimodal deep research tasks that require visual elements to serve specific analytical sub-goals, and TVIR-Agent, a hierarchical multi-agent framework that serves as a strong baseline for constructing outlines, retrieving images, generating charts with traceable sources, and composing reports through context-aware sequential writing. We further develop a dual-path evaluation framework that combines Textual Assessment and Visual Assessment. Experiments across nine deep research systems show that TVIR-Agent achieves strong overall performance, underscoring the importance of explicit multimodal design and evaluation for evidence-driven report generation.

21.
bioRxiv (Bioinfo) 2026-06-16

FlowBench: separating planning, fault recovery and interpretation in agentic bioinformatics

Agentic large language model (LLM) systems are being deployed in bioinformatics faster than they are understood, and single-metric evaluations conflate capabilities that fail independently. We introduce FlowBench, a benchmark that decomposes agentic bioinformatics performance into planning, fault recovery, biological interpretation, and end-to-end output-fidelity. Existing systems achieve high plan completeness, but their closed, single-provider designs prevent attribution of performance to scaffolding versus the underlying model. We therefore built FlowAgent, a modular, provider-agnostic framework whose components can be selectively disabled and whose backbone model can be swapped across providers on a shared harness, and used it to evaluate 23 models from three main providers. Three findings emerge. First, generating a valid workflow plan from a named toolchain is largely solved, whereas inferring an appropriate toolchain from biological intent alone is uniformly difficult regardless of model tier, compressing all models into a narrow 44-57% pass-rate band. Second, ablation shows that the dependency-structured plan and a completeness-reflection step drive performance, while adding a same-context validator-driven retry makes structural quality worse. Third, fault recovery and data-grounded interpretation remain unsolved. Models frequently propose fixes that force a clean exit while leaving the underlying data invalid, and data-grounded interpretation lags internal-knowledge recall by a consistent margin. Safety does not emerge from capability, and reasoning-tier models were among the least reliable at recognising unrecoverable faults. Once planning saturates, agent architecture and refusal calibration, not model scale, are the productive frontier.

22.
arXiv (CS.AI) 2026-06-17

Dimensionality Controls When Modularity Helps in Continual Learning

arXiv:2606.17889v1 Announce Type: cross Abstract: Compositional learning systems must balance plasticity, the ability to acquire new knowledge, with stability, the preservation of previously learned components, especially when tasks share structure and risk interference. We study how modular architecture, task similarity, and representational dimensionality jointly shape compositional continual learning in a sequential A-B-A paradigm, comparing a task-partitioned recurrent network to a single-network baseline while inducing high- and low-dimensional regimes via weight-scale manipulations. In a high-dimensional "lazy" regime, both architectures achieve similar performance and internal geometry, suggesting that explicit modular structure has little impact when representations are weakly constrained. In a lower-dimensional "rich" regime, modularity becomes decisive: the modular network develops graded task-specific subspaces that overlap for similar tasks, partially align for moderately dissimilar tasks, and separate for dissimilar tasks, yielding a more compositional and interpretable organization than the single network. These findings identify the representational regime induced by initialization scale, which co-varies with representational dimensionality, as a key factor governing when compositional, modular structure is functionally beneficial in continual learning, and support viewing safety and robustness as problems of adaptive allocation of representational subspaces rather than fixed separation versus sharing.

23.
arXiv (CS.CV) 2026-06-11

Beyond Dark Knowledge: Mixup-Based Distillation for Reliable Predictions

Knowledge Distillation (KD) and mixup have proven effective at inducing smoothness in class boundaries; KD captures inherent class relationships in probability distributions, and mixup enforces them through convex combinations of inputs. Their interaction, however, remains poorly understood, particularly when mixup is applied only during student training. In this setting, the teacher is queried on inputs drawn from a vicinal distribution it never saw during training, a controlled mismatch whose effect on knowledge transfer has not been characterised. We show that this mismatch causes the teacher's supervisory signal to be dominated by distributional confusion rather than inter-class structure. Despite it, the student does not merely imitate the teacher: it independently acquires greater linearity in the vicinal region, a structural property that the teacher lacks, and goes beyond dark-knowledge transfer. KD with mixup consistently improves student accuracy and reduces overconfidence by an order of magnitude relative to the baseline, across CIFAR and ImageNet with varying-capacity teachers. Crucially, calibration propagates from teacher to student independently of accuracy transfer, and temperature scaling governs a measurable accuracy-calibration trade-off that becomes more pronounced under vicinal training. These results reframe mixup distillation not as a degraded version of standard KD, but as a richer transfer channel that simultaneously shapes discriminative performance, uncertainty estimation, and representational geometry.

24.
PLOS Medicine 2026-05-21

Semaglutide-associated risk of nonarteritic anterior ischemic optic neuropathy in patients with type 2 diabetes: A systematic review and meta-analysis of observational studies

by Jędrzej Chrzanowski, Magdalena Walicka, Jacek Burzyński, Małgorzata Zaraś, Arkadiusz Michalak, Wojciech Fendler Background Semaglutide, a glucagon-like peptide-1 receptor agonist, is widely used for the management of type 2 diabetes (T2DM). Recent case reports have raised concerns about a potential association between semaglutide use and the development of nonarteritic anterior ischemic optic neuropathy (NAION), a rare but vision-threatening condition. We aimed to evaluate whether semaglutide use is associated with an increased risk of NAION in patients with T2DM. Methods and findings We conducted a systematic review and meta-analysis of observational studies comparing patients with T2DM aged ≥12 years treated with semaglutide to those receiving other glucose-lowering therapies. We searched PubMed, Scopus, and Web of Science databases from January 2023 to November 2025. Two reviewers independently extracted data on study design, population characteristics, and outcomes. Risk of bias was assessed using the Newcastle–Ottawa Scale, and ROBINS-I v.2. Certainty of the evidence was graded according to the GRADE framework. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using fixed-effects models; sensitivity analyses included crude and subgroup HRs, and overlapping study replacement. Leave-one-out analysis was conducted to assess small-study effects and publication bias. Results were contextualized within other meta-analyses, systematic reviews, consensus statements, and regulatory communications on the topic.Five eligible observational studies met the inclusion criteria, and 7 additional studies were included in the sensitivity analysis. Semaglutide use was associated with a significantly increased hazard of NAION compared with nonsemaglutide glucose-lowering regimens (HR 2.17, 95% CI [1.73, 2.74]; p