Can Jardiance (empagliflozin) cause floaters in vision?

Can Jardiance (Empagliflozin) Cause Floaters in Vision?

While Jardiance (empagliflozin) is not directly associated with causing floaters in vision, it may indirectly contribute to visual disturbances through its effects on the vitreous humor or by inducing posterior vitreous detachment in susceptible individuals.

Mechanism of Visual Floaters

Floaters are most commonly caused by posterior vitreous detachment (PVD), which can occur:

• As a natural aging process (typically between ages 45-65)
• In association with certain medications or conditions that affect vitreous composition
• Secondary to changes in ocular blood flow or metabolism

Evidence Regarding Empagliflozin and Visual Effects

The available guidelines and evidence do not specifically list floaters as a common adverse effect of empagliflozin. However, there are several potential mechanisms through which SGLT2 inhibitors like Jardiance might influence visual symptoms:

1. Osmotic Effects: SGLT2 inhibitors cause osmotic diuresis, which could theoretically alter fluid balance in the eye 1

2. Metabolic Changes: The shift toward ketone metabolism with SGLT2 inhibitors might affect ocular tissues 1

3. Vascular Effects: Changes in blood pressure and vascular function could influence ocular blood flow 1

Documented Visual Side Effects of SGLT2 Inhibitors

The most recent ophthalmology guidelines mention:

• Photopsia (perception of flashes of light) can occur with posterior vitreous detachment 1
• Vitreous floaters are a known complication of PVD and can be triggered by various factors 1, 2

However, clinical trials and post-marketing surveillance of empagliflozin have primarily focused on:

• Genital infections
• Urinary tract infections
• Risk of diabetic ketoacidosis
• Cardiovascular outcomes
• Renal effects

Visual side effects are not prominently featured in the safety profile 1, 3, 4.

Recent Research on Empagliflozin and Retinopathy

A recent study published in JAMA Ophthalmology (2025) found that:

• Empagliflozin was not associated with increased risk of incident nonproliferative diabetic retinopathy
• Empagliflozin may actually be associated with a lower risk of diabetic retinopathy progression compared to DPP4 inhibitors 5

Clinical Approach to Patients on Jardiance Reporting Floaters

If a patient on Jardiance reports new floaters:

1. Urgent Ophthalmologic Evaluation is recommended if:

   • Floaters are sudden in onset or rapidly increasing
   • Accompanied by flashes of light (photopsia)
   • Associated with visual field defects or shadows
   • Accompanied by decreased vision 2

2. Diagnostic Testing:

   • Complete dilated fundus examination to assess for retinal tears or detachment
   • Optical coherence tomography (OCT) to evaluate macular integrity
   • Visual field testing if indicated 2

3. Management Considerations:

   • Do not discontinue Jardiance based solely on floaters without ophthalmologic evaluation
   • If serious retinal pathology is found, discuss risks/benefits of continuing Jardiance with ophthalmology
   • Monitor for other potential side effects of Jardiance that might require dose adjustment or discontinuation

Conclusion

While there is no strong direct evidence linking Jardiance to floaters, patients should be advised to report any new visual symptoms promptly. The benefits of empagliflozin in reducing cardiovascular mortality and progression of diabetic kidney disease generally outweigh potential risks in appropriate patients, but visual symptoms should be evaluated promptly by an ophthalmologist.