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Does semaglutide really contribute to vision loss?

Does semaglutide really contribute to vision loss?

Medical News Today15 hours ago
As the popularity of GLP-1 medications used for weight loss continues to increase, more research is being done to further examine potential side effects of these medications. One such side effect is possible eye issues and vision loss, for which there is currently a great deal of conflicting information.Some studies link GLP-1 use to an increased risk for ocular diseases such as nonarteritic anterior ischemic optic neuropathy (NAION), diabetic retinopathy, papillitis, and optic nerve disorders. A new study reports that using semaglutide is not associated with an increased risk for eye disorders or diabetic retinopathy.While this new study found a connection between semaglutide use and NAION, researchers say that the current evidence is insufficient to establish a definitive connection between the two. As the popularity of glucagon-like peptide-1 receptor agonists (GLP-1) used for the treatment of diabetes and in some cases for weight loss continues to increase, more research is being done to further examine potential side effects of these medications. One such side effect is possible eye issues and vision loss, for which there is currently a great deal of conflicting information. For example, a study published in July 2024 found participants taking semaglutide — the active ingredient found in Ozempic and Wegovy — were potentially at a higher risk of developing nonarteritic anterior ischemic optic neuropathy (NAION). Research published in February 2025 linked use of both semaglutide and tirzepatide — the active ingredient in Zepbound and Mounjaro — to not only an increased risk for NAION, but also papillitis and paracentral acute middle maculopathy. More recently, two studies published earlier this month showed similar findings. One study discovered that those taking semaglutide or tirzepatide may be at a higher risk of developing NAION than previously reported, as well as an increased risk of developing other optic nerve disorders.And while the second study did not find a correlation between GLP-1 use and an increased risk for NAION, it did report a possible heightened chance for diabetic retinopathy.Now an additional study, also published this month in the journal JAMA Ophthalmology, reports that semaglutide is not associated with an increased risk for eye disorders or diabetic retinopathy.And while the study did find a connection between semaglutide use and NAION, researchers say that the current evidence is insufficient to establish a definitive connection between the two. Why is there so much conflicting information on GLP-1s and eye issues? For those currently using or considering using GLP-1 medications, it can be confusing and frustrating to have multiple studies with differing — and sometimes conflicting — findings around a potential risk to eye health and vision. 'We've seen a couple of studies now that are coming out, especially because of how regularly these medications are being used now,' Benjamin Bert, MD, a board-certified ophthalmologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA — who was not involved in any of these studies — told Medical News Today.'And as expected, when we're talking about rare diseases, especially things like NAION, we do see some variability in the results that have been coming out,' added Bert.'Most of the research that's been published, including one of these two recent studies, does continue to support the idea that there is an increased risk of NAION occurring in patients that are taking these GLP-1 medications,' he continued.'It really just tells me that it's important, again, to go over all the risks and benefits with the patients of these different medications, and just let them know, hey, this is something new, we're still finding out about it, but there have been these reports of increasing the incidence,' Bert told us. 'We are seeing so many patients utilizing these drugs [that] we will see other complications during patient use that some would attribute to side effects of the medication,' David I. Geffen, OD, FAAO, director of optometric and refractive services at the Gordon Schanzlin New Vision Institute in La Jolla, CA, who was not involved in the research, explained to MNT. 'At this time early research in general shows the plus side of these medications outweighs some potential side effects.'Semaglutide not associated with diabetic retinopathy or eye disordersIn this most recent study, researchers conducted a systematic review of 78 clinical trials involving semaglutide use and ocular issues — including NAION, diabetic retinopathy, and eye disorders — encompassing more than 73,000 study participants. 'The risk of diabetic retinopathy came with the results of the SUSTAIN 6 trial, the first that compared the effect of semaglutide in cardiovascular outcomes in subjects with type 2 diabetes,' Fernando Gerchman, MD, PhD, professor of medicine in the Division of Endocrinology and Metabolism at the Hospital de Clínicas de Porto Alegre in Brazil and senior author of this study, told MNT. 'Observational data demonstrated a possible association between semaglutide and NAION,' Gerchman continued. 'This was replicated for others, but not in all studies published that look at this. We had the unique opportunity to meta-analyze with data derived from clinical trials. Our results confirmed these findings. However, there is some imprecision in our analyses and our findings need to be replicated.' Upon analysis, researchers found that semaglutide use was not associated with an increased risk for diabetic retinopathy or eye disorders. And although they did find a correlation between semaglutide use and NAION, scientists believe the evidence currently available is not enough to establish a definitive conclusion and more studies are needed.'These findings reassure [those] who prescribe semaglutide about the safety of doing that in diabetes and obesity,' Gerchman said. 'The risk of NAION needs to be taken into account and may help to decide about a more conservative approach in the definition of beginning semaglutide for those subjects without a clear indication for that.'Do I need to worry about my eyes when taking Ozempic? When looking at the results of these studies, Bert said it's important to note that when looking at the increases of percentages, it demonstrates that it is still very, very rare for a condition like NAION to occur.'[This study] reported in the control population that it was about 0.02% of the patients (with NAION), and in the treated group, the ones that were taking the GLP-1 medications, it went up to 0.04%,' he explained. 'So you could kind of sensationalize it and say, look, it doubled the risk for the patients to take the medication. But again, 0.02 to 0.04 is such a small amount that the overall risk is still very low.' Geffen commented that it is hard to tell a patient not to take GLP-1 medications unless they are already at high risk for NAION.'I feel the benefits for overall health make it a risk for the average person to take,' he continued. 'We need better studies developed for all the potential side effects of GLP-1 medications, not just eye related ones. So far these meds seem a godsend for many individuals.' For those considering starting GLP-1 medications, Bert advised talking to their physician and endocrinologist, and make sure to have an annual eye exam. 'It would be beneficial to have a baseline exam before you start the medication,' he explained. 'And then if you are high risk, of course, have another exam done shortly after starting just to make sure that you're not one of the people that fall into one of those categories where there can be worsening of the disease.' 'I think it's most important that these types of research projects continue to be done, and the benefit of having our electronic medical record systems, and we see in other countries that have kind of universal systems, you can do these very large population-based statistical analyses. And I think that needs to be continued as we progress into using these medications for longer periods of time, to ensure that we know the entirety of the risks and the benefits of them. So I would like to just continue to see this research being done and all these details flushed out.' – Benjamin Bert, MD
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