Vision Problems with Ozempic (Semaglutide)
If you experience vision changes while taking Ozempic, contact your healthcare provider immediately and obtain an urgent ophthalmology evaluation, as semaglutide has been associated with serious ocular complications including diabetic retinopathy worsening and nonarteritic anterior ischemic optic neuropathy (NAION). 1, 2
Immediate Actions for Vision Changes
Stop and seek same-day ophthalmologic assessment if you experience: 3
- Visual acuity loss
- Eye pain
- Photophobia (light sensitivity)
- Blurred vision
- Blind spots or shadows in your vision
- Changes in color vision
- Any visible changes to your eyes
The FDA-approved drug label explicitly states patients should "tell your healthcare provider if you have changes in vision during treatment with OZEMPIC." 1
Primary Ocular Risks with Semaglutide
Diabetic Retinopathy Complications
Semaglutide carries an increased risk of rapidly worsening diabetic retinopathy, particularly in patients with pre-existing retinal disease. 3 The American Diabetes Association recommends assessing retinopathy status before intensifying glucose-lowering therapies with GLP-1 receptor agonists like Ozempic. 3
Higher risk patients include: 4
- Age ≥60 years (RR 1.27,95% CI 1.02-1.59)
- Diabetes duration ≥10 years (RR 1.28,95% CI 1.04-1.58)
- Pre-existing diabetic retinopathy
The mechanism appears related to rapid glycemic improvement rather than direct drug toxicity—a phenomenon observed with other intensive glucose-lowering treatments. 3, 5
Nonarteritic Anterior Ischemic Optic Neuropathy (NAION)
Recent evidence demonstrates a significant association between semaglutide and NAION, a serious cause of vision loss. 2 In patients with type 2 diabetes prescribed semaglutide, the hazard ratio for NAION was 4.28 (95% CI 1.62-11.29, P<0.001) compared to non-GLP-1 RA medications. 2
For patients prescribed semaglutide for weight loss, the risk was even higher with a hazard ratio of 7.64 (95% CI 2.21-26.36, P<0.001). 2
- Sudden, painless vision loss
- Optic disc edema on examination
- Visual field defects
- May progress sequentially to the fellow eye
Required Baseline and Monitoring Evaluations
Before Starting Ozempic
All patients with diabetes should have a dilated eye examination at the time of type 2 diabetes diagnosis, before initiating semaglutide. 3 This establishes baseline retinopathy status and identifies high-risk patients who require closer monitoring.
During Treatment
Monitor for these specific visual symptoms: 7
- Blurriness
- Blind spots or shadows in central vision
- Sensitivity to light
- Unusually colored vision
- Distorted contour and color of objects
- Unequal size with monocular view
Patients with diabetes, history of uveitis, or macular edema require regular ophthalmologic examinations throughout treatment. 7
Clinical Decision-Making Algorithm
Step 1: Risk Stratification Before Prescribing
- Obtain dilated fundoscopic examination for all diabetic patients 3
- Document presence and severity of any retinopathy
- Assess diabetes duration and glycemic control history
- Consider alternative agents in patients with moderate-to-severe retinopathy
Step 2: If Vision Changes Occur During Treatment
- Same-day ophthalmology referral for any visual symptoms 3
- Do not wait to see if symptoms resolve
- Document timing relative to semaglutide initiation and dose changes
- Check current HbA1c and compare to baseline
Step 3: Management Based on Findings
For diabetic retinopathy worsening: 3
- Consider slowing rate of glycemic improvement
- Increase ophthalmology follow-up frequency
- Weigh risks/benefits of continuing semaglutide
For NAION or other ischemic events: 6, 5
- Discontinue semaglutide
- Initiate corticosteroid treatment if indicated by ophthalmology
- Optimize glycemic control with alternative agents
- Monitor fellow eye closely for sequential involvement
Critical Pitfalls to Avoid
Do not attribute all vision problems to semaglutide without proper ophthalmologic evaluation—other diabetic complications or unrelated conditions may be present. 3
Do not assume vision changes are benign or temporary—serious complications like NAION can cause permanent vision loss if not promptly evaluated. 2, 5
Do not overlook the timing of symptom onset—vision problems developing within months of starting semaglutide warrant particular concern for drug-associated complications. 6, 5
The temporary worsening of retinopathy with rapid glycemic improvement is well-documented with intensive diabetes treatments, but this does not diminish the need for urgent evaluation when it occurs. 3
Additional Ocular Considerations
Beyond retinopathy and NAION, case reports describe other complications including bilateral papillitis and paracentral acute middle maculopathy in semaglutide users. 5 Atypical features such as sequential ischemic optic neuropathy and progressive vision loss have been reported. 5
The evidence suggests causality remains under investigation, but the association is strong enough to warrant heightened clinical vigilance and patient counseling about ocular risks before initiating therapy. 2, 5