What to do with a diabetic patient experiencing intermittent blurred vision while on Ozempic (semaglutide)?

Management of Diabetic Patient with Intermittent Blurred Vision on Ozempic

A diabetic patient experiencing intermittent blurred vision while on Ozempic (semaglutide) should be promptly referred to an ophthalmologist for a comprehensive dilated eye examination to rule out diabetic retinopathy complications.

Understanding the Risk

Semaglutide (Ozempic) carries a specific warning regarding diabetic retinopathy complications. According to the FDA label:

• In clinical trials, more events of diabetic retinopathy complications occurred in patients treated with Ozempic (3.0%) compared to placebo (1.8%) 1
• The absolute risk increase was significantly higher among patients with pre-existing diabetic retinopathy (Ozempic 8.2%, placebo 5.2%) 1
• Rapid improvement in glucose control has been associated with temporary worsening of diabetic retinopathy 1

Immediate Management Steps

1. Ophthalmologic Referral

   • All patients with diabetes experiencing vision changes should be promptly referred to an ophthalmologist experienced in diagnosing and managing diabetic retinopathy 2
   • This is particularly urgent for patients on GLP-1 receptor agonists like Ozempic 3

2. Assess Retinopathy Status

   • Determine if the patient has pre-existing diabetic retinopathy
   • Patients with any level of macular edema, severe non-proliferative diabetic retinopathy (NPDR), or any proliferative diabetic retinopathy (PDR) require prompt care by an ophthalmologist 2

3. Evaluate Glycemic Control

   • Review recent A1C values and assess for rapid improvements in glycemic control
   • Rapid glucose reduction with GLP-1 RAs can temporarily worsen retinopathy 3, 1

Medication Management Considerations

• For patients with established retinopathy:

  • Consider slower titration of semaglutide to minimize rapid glucose reduction 3
  • Discuss with the ophthalmologist whether medication adjustment is necessary

• For patients without established retinopathy:

  • Continue current therapy with close monitoring
  • The benefits of GLP-1 RAs for glycemic control, weight management, and cardiovascular risk reduction should be weighed against potential retinopathy progression risk 3

Follow-up Recommendations

• Patients with any level of diabetic retinopathy:

  • Annual (or more frequent) dilated retinal examinations by an ophthalmologist 2
  • More frequent examinations if retinopathy is progressing 2

• Patients without retinopathy:

  • Eye examinations every 1-2 years if glycemic control is good 2

Important Considerations

• Blurred vision may be the first and only presenting symptom of uncontrolled diabetes 4

• Intermittent blurred vision could represent:

  1. Diabetic macular edema
  2. Early diabetic retinopathy
  3. Transient refractive changes due to glucose fluctuations
  4. Other ocular complications

• Patients should be advised to report any vision changes immediately 3

Prevention Strategies

• Optimize glycemic control to reduce risk or slow progression of diabetic retinopathy 2
• Optimize blood pressure and serum lipid control 2
• Ensure regular eye examinations as recommended for diabetic patients 2

Remember that early detection and treatment of diabetic retinopathy can reduce the risk of vision loss by up to 90% 2. The combination of appropriate medical management and timely ophthalmologic care is essential for preserving vision in patients with diabetes experiencing visual symptoms while on Ozempic.