Semaglutide Use Linked to Increased Risk of Rare Eye Condition, Pointing to Potential Vascular Mechanisms in Diabetes and Obesity Management
A study published in JAMA Ophthalmology has identified a potential association between semaglutide use and an increased risk of nonarteritic anterior ischemic optic neuropathy (NAION), a rare but serious eye condition. Researchers at Mass Eye and Ear in Boston found that patients taking semaglutide for diabetes or obesity were significantly more likely to develop NAION compared to those on other medications. This finding raises important questions about the vascular effects of GLP-1 agonists and their potential impact on ocular health, particularly in patients with pre-existing risk factors.
Key Points:
- NAION affects approximately 2.3 per 100,000 people in the United States annually
- The study analyzed data from 16,827 patients at Mass Eye and Ear
- In the diabetes group, 8.9% of semaglutide users received a NAION diagnosis, compared to 1.8% of those on other diabetes medications
- Among patients with obesity, 6.7% of semaglutide users developed NAION, versus 0.8% of those on other weight loss medications
- Patients with diabetes taking semaglutide were more than four times more likely to receive a NAION diagnosis
- Those taking semaglutide for obesity were more than seven times more likely to receive a NAION diagnosis
- NAION causes painless, permanent vision loss, often occurring upon waking from sleep
- The condition typically affects middle-aged or older white individuals and is considered irreversible
- Approximately 43% of patients experience involvement of the other eye within 3 years
- Potential mechanisms linking semaglutide to NAION include:
- Influence on vascular health and blood flow
- Activation of GLP-1 receptors present on the optic nerve, potentially affecting blood supply
- To reduce NAION risk, experts recommend:
- Controlling blood pressure and diabetes
- Regular eye examinations
- Maintaining a healthy lifestyle (balanced diet, regular exercise, avoiding smoking)
- Study limitations include:
- Potential overrepresentation of NAION cases due to the specialized nature of the institution
- Lack of data on patient adherence to prescribed medications
- Small number of NAION cases, potentially affecting statistical interpretation
- Physicians are advised to include this information in discussions with patients, especially those with pre-existing optic nerve problems or significant visual loss from other causes
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“Our findings should be viewed as being significant but tentative, as future studies are needed to examine these questions in a much larger and more diverse population.”
– Joseph Rizzo, MD, Director of the Neuro-Ophthalmology Service at Mass Eye and Ear in Boston, MA
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