A recent study published in JAMA Ophthalmology has unveiled a concerning link between the use of GLP-1 medications, such as semaglutide, and rare eye conditions. Conducted by Dr. Bradley Katz at the University of Utah, the research identified a potential connection between semaglutide and nonarteritic anterior ischemic optic neuropathy (NAION), a stroke of the optic nerve that may lead to irreversible vision loss. The study involved nine participants who experienced vision issues, including NAION and two other potentially blinding conditions—papillitis and paracentral acute middle maculopathy.
Dr. Katz, an ophthalmologist at the John A. Moran Eye Center, emphasized the importance of further research into the ocular effects of GLP-1 medications, particularly given their widespread use. Approximately 2-3% of the U.S. population received prescriptions for these drugs in 2023. The study suggests that these medications could lower the blood flow to the optic nerve, heightening the risk of developing NAION.
“What we are recommending is that if you experience a change in your vision while using one of these drugs, you should consult the prescribing doctor and see an ophthalmologist. We are also recommending that if patients are starting these drugs or increasing the dose of these drugs, they should do so slowly to reduce the risk of dropping their blood sugar and causing an osmotic shift.” – Bradley Katz, MD, PhD
The study's findings have raised significant concerns within the medical community about the need for monitoring patients on GLP-1 medications for potential eye complications. Despite mounting evidence linking these drugs to serious eye conditions, the FDA has yet to mandate a post-marketing survey to determine the true incidence of such complications. Dr. Katz and other physicians are advocating for this crucial step to ensure patient safety.
“We as well as other concerned physicians are also asking FDA to mandate a post-marketing survey of these drugs to find the true incidence of eye complications associated with them. We are in discussions with other groups around the U.S. who want to do a more comprehensive review of these medications and potential ocular side effects,” – Bradley Katz, MD, PhD
The study's results highlight the necessity for patients to be vigilant about their eye health while on GLP-1 medications. Dr. Mir Ali, another expert in the field, advises that individuals who notice significant changes in their vision should promptly contact their healthcare provider. He also noted that while eye problems remain rare, awareness of potential side effects is paramount given the prevalence of these medications.
“As with all medications, if a patient notices a significant change in vision, or any other system, they should contact their prescribing provider. Since there is widespread use of these medications, it is important for people to be aware of all potential side effects and complications. However, since eye problems are very rare, it probably would not impact the frequency people on these medications should have their eyes examined.” – Mir Ali, MD
The study further underscores the potential risks associated with GLP-1 medications and urges those at risk for eye problems to consider alternative treatments. Regular eye exams are recommended for individuals with underlying conditions that may predispose them to adverse ocular effects.
“Those who wish to take an extra step of caution, may choose to have an eye exam prior to initiating treatment to determine their ocular health status and to query if they may have a ‘disc-at-risk,’ in that the large majority of those who may acquire NAION have a c/d ratio less than or equal to 0.3,” – Krauss
Despite these concerns, it remains challenging to pinpoint the exact mechanism by which GLP-1 medications might cause these rare complications due to their uncommon occurrence.
“Since this is so rare a complication, in so few patients, it is difficult to delineate the exact mechanism; I really can’t comment on why this would happen.” – Mir Ali, MD
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