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Recent investigatory review published in JAMA Ophthalmology examines vision-related complications in patients taking GLP-1 receptor agonists (semaglutide and tirzepatide). The study analyzes nine cases of potentially blinding eye conditions, building on previous research from July 2024 that initially identified links between semaglutide and Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION), a stroke of the optic nerve.
Key Clinical Considerations
- Population Impact: Study reports that 2-3% of US population received GLP-1 prescriptions in 2023, highlighting widespread exposure and surveillance importance
- Case Demographics: Nine patients (5 female, 4 male), average age 58 years, developed three distinct vision conditions while on GLP-1 medications
- Condition Distribution: Seven patients developed NAION, one experienced retinal stroke, and one presented with bilateral optic nerve swelling without vision loss
- Proposed Mechanism: Rapid blood sugar reduction may cause osmotic shifts, leading to optic nerve swelling and potential complications in ocular vasculature
- Risk Assessment Tool: C/D ratio ≤0.3 identified as potential risk factor for NAION development in GLP-1 medication users
Clinical Practice Impact
- Recommendations emphasize continued GLP-1 use under physician guidance but suggest baseline ophthalmologic examination before initiation, particularly assessing c/d ratio.
- Gradual dose escalation advised to minimize rapid blood sugar fluctuations.
- Implementation requires coordinated care between prescribing physicians and ophthalmologists, with clear patient education about vision-related warning signs.
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