Is Ozempic (semaglutide) associated with eye problems?

Ozempic (Semaglutide) and Eye Problems

Ozempic (semaglutide) can cause worsening of diabetic retinopathy, particularly in patients with pre-existing retinopathy and when rapid glycemic improvement occurs. 1, 2

Relationship Between Semaglutide and Eye Problems

Diabetic Retinopathy

• Semaglutide has been associated with an increased risk of rapidly worsening diabetic retinopathy in randomized trials 1
• In a 2-year trial involving patients with type 2 diabetes and high cardiovascular risk, more events of diabetic retinopathy complications occurred in patients treated with Ozempic (3.0%) compared to placebo (1.8%) 2
• The absolute risk increase for diabetic retinopathy complications was larger among patients with a history of diabetic retinopathy at baseline (Ozempic 8.2%, placebo 5.2%) than among patients without a known history of diabetic retinopathy (Ozempic 0.7%, placebo 0.4%) 2

Mechanism of Eye Problems

• Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy 2
• The effect of long-term glycemic control with semaglutide on diabetic retinopathy complications has not been fully studied 2
• A meta-analysis of data from cardiovascular outcomes studies showed no direct association between GLP-1 receptor agonist treatment and retinopathy per se, except through the association between retinopathy and average A1C reduction 1

Other Potential Eye Complications

• There have been case reports of non-arteritic anterior ischemic optic neuropathy (NAION) in patients taking semaglutide 3, 4
• A 55-year-old female with type 2 diabetes developed blurred vision and optic disc edema after four months of semaglutide therapy, which progressed to NAION 3

Risk Factors for Eye Problems with Semaglutide

• Pre-existing diabetic retinopathy 2
• Rapid reduction in A1C levels 1
• Age ≥ 60 years 5
• Diabetes duration ≥ 10 years 5
• Crowded optic discs (a characteristic that can be identified by proactive eye examination) 4

Monitoring and Management Recommendations

Screening Recommendations

• Retinopathy status should be assessed when intensifying glucose-lowering therapies such as those using GLP-1 receptor agonists 1
• Adults with type 1 diabetes should have an initial dilated eye examination within 5 years after diabetes onset 1
• People with type 2 diabetes should have an initial dilated eye examination at the time of diagnosis 1
• If there is no evidence of retinopathy and glycemic indicators are within goal range, screening every 1-2 years may be considered 1
• If any level of diabetic retinopathy is present, dilated retinal examinations should be repeated at least annually 1

Management of Patients on Semaglutide

• Patients with a history of diabetic retinopathy should be monitored for progression of diabetic retinopathy 2
• Inform patients to contact their physician if changes in vision are experienced during treatment with Ozempic 2
• Consider the risk-benefit profile of semaglutide in patients with pre-existing diabetic retinopathy 1, 2

Research Evidence and Controversies

• A 2022 meta-analysis of 23 randomized trials involving 22,096 patients found that overall, semaglutide was not associated with increased diabetic retinopathy risk compared with controls (RR 1.14,95% CI 0.98-1.33) 5
• However, subgroup analysis showed that semaglutide was associated with an increased risk of diabetic retinopathy compared with placebo (RR 1.24,95% CI 1.03-1.50) 5
• Some research suggests that topical semaglutide may actually have beneficial effects on retinal neuroinflammation and vascular leakage in experimental diabetes models 6
• GLP-1 receptor expression is low in normal human eyes and was not detected in eyes exhibiting advanced stages of proliferative diabetic retinopathy 7

Common Pitfalls and Caveats

• Do not attribute all eye problems in patients taking semaglutide to the medication without proper ophthalmologic evaluation 8
• The risk of diabetic retinopathy complications appears to be highest in patients with pre-existing retinopathy 2
• The temporary worsening of retinopathy with rapid glycemic improvement is a phenomenon that has been observed with other intensive glucose-lowering treatments, not just with semaglutide 1
• The FDA label for Ozempic specifically mentions diabetic retinopathy complications as a warning and precaution, but does not mention other eye problems 2