Can Wegovy (semaglutide) cause blurred vision?

Wegovy (Semaglutide) and Blurred Vision

Wegovy (semaglutide) can cause blurred vision as a potential side effect, with recent evidence suggesting an association with serious ophthalmic complications including nonarteritic anterior ischemic optic neuropathy (NAION).

Mechanism and Evidence

Semaglutide is a GLP-1 receptor agonist approved for weight management and has demonstrated significant benefits for weight loss and cardiovascular outcomes. However, several ophthalmic complications have been reported:

1. Recent research evidence (2024-2025) shows concerning associations:

   • A retrospective matched cohort study found that patients prescribed semaglutide had a significantly higher risk of NAION compared to those on non-GLP-1 RA medications:
     • In patients with type 2 diabetes: HR 4.28 (95% CI, 1.62-11.29; P<0.001) 1
     • In patients with obesity: HR 7.64 (95% CI, 2.21-26.36; P<0.001) 1

2. Potential mechanisms for visual disturbances may include:

   • Rapid correction of hyperglycemia rather than direct toxicity 2
   • Delayed gastric emptying, which is a known effect of GLP-1 RAs 3
   • Possible vascular effects, as GLP-1 receptors are present in the vasculature 3

Clinical Presentation and Types of Visual Disturbances

Visual disturbances associated with semaglutide may present as:

• Blurred vision (non-specific)
• Nonarteritic anterior ischemic optic neuropathy (NAION)
• Bilateral papillitis
• Paracentral acute middle maculopathy
• Progressive vision loss
• Visual field defects 2

Risk Factors and Monitoring

Patients at higher risk may include those with:

• Pre-existing diabetic retinopathy
• Cardiovascular risk factors
• Rapid weight loss
• Rapid glycemic improvement

Monitoring recommendations:

• Baseline eye examination before starting therapy, especially in patients with diabetes
• Regular follow-up eye examinations
• Immediate ophthalmologic evaluation if visual symptoms develop

Management of Visual Disturbances

If a patient on Wegovy reports blurred vision:

1. Immediate assessment of visual symptoms including:

   • Onset and progression
   • Unilateral vs. bilateral involvement
   • Associated symptoms (pain, photophobia, etc.)

2. Prompt referral to an ophthalmologist for:

   • Visual acuity testing
   • Visual field assessment
   • Fundoscopic examination

3. Consider medication adjustment:

   • Temporary discontinuation may be necessary if symptoms are severe
   • Dose reduction could be considered in milder cases
   • Permanent discontinuation may be required for confirmed serious ophthalmic complications

Important Caveats

• While the association between semaglutide and visual disturbances exists, causality has not been definitively established 1, 2
• The benefits of semaglutide for weight management and cardiovascular risk reduction must be weighed against potential risks
• Patients should be informed about possible visual side effects and instructed to report any visual changes promptly
• The risk appears higher in certain populations, particularly those with diabetes or obesity

Other Safety Considerations with Wegovy

Beyond visual disturbances, other important safety considerations with Wegovy include:

• Gastrointestinal side effects (nausea, vomiting, diarrhea) 3
• Potential risk of pancreatitis 3
• Risk of gallbladder disease 3
• Contraindicated in pregnancy and patients with personal/family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 3

Remember that while blurred vision is a potential side effect of Wegovy, the medication has demonstrated significant benefits for weight management and cardiovascular outcomes that should be considered in the overall risk-benefit assessment.