There could be a potential risk of vision loss associated with the widely prescribed weight loss and anti-diabetic drug Semaglutide, a study published in the medical journal JAMA Ophthalmology has found.
The study conducted by Boston-based researchers found that there is a potential risk of the development of non-arteritic ischemic optic neuropathy (NAION) associated with prescriptions for Semaglutide, the drug which is approved to treat obesity and type 2 diabetes. NAION is a potentially debilitating condition caused by insufficient blood flow to the optic nerve that could lead to sudden vision loss.
In the study titled “Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide”, the authors referenced anecdotal evidence suggesting that constant use of the drug — which is a glucagon-like peptide 1 receptor agonist (GLP-1 RA) — may be linked to the development of such a condition.
However, the authors also suggest further research.
“This study’s findings suggest an association between semaglutide and NAION. As this was an observational study, future study is required to assess causality,” the authors clarified.
Semaglutide is sold under the brand names of Wegovy, Rybelsus and Ozempic. According to the study, NAION is the second-most common form of optic neuropathy and a significant cause of blindness among adults. “The incidence of NAION is 2 to 10 cases per 100,000 persons, making it the second most common cause of blindness due to optic nerve damage (with glaucoma being the most common).”
Higher risk but reason unclear: Study
The study identified 16, 827 patients for analysis. Among the included patients, 710 had type 2 diabetes and 979 were overweight or obese.
The researchers – led by Jimena Tatiana Hathaway from Harvard T.H. Chan School of Public Health, Boston, Massachusetts – searched a centralised data registry of patients who had undergone neuro-ophthalmologic evaluations at a single academic institution from December 1, 2017, to November 30, 2023.
In patients with type 2 diabetes, the authors reported 17 NAION events in those prescribed Semaglutide compared to 6 in the non–GLP–1 RA antidiabetes cohort. The cumulative incidence rates of NAION over 36 months were 8.9 per cent for the Semaglutide group. The analysis indicated that patients treated with Semaglutide had a higher risk of developing NAION compared to those on non-GLP-1 RA antidiabetes medications. Among overweight or obese patients, a similar pattern was observed, with 20 NAION events in the Semaglutide group versus 3 in the non–GLP–1 RA cohort, resulting in cumulative incidence rates of 6.7 per cent over 36 months.
However, the authors concluded that “despite extensive study, the pathogenesis of NAION has not been fully elucidated”.
Need better studies to prove: Experts
According to eye specialists, the findings are important and cannot be undermined.
Dr Sanjiv Gupta, director and senior eye surgeon at i Care Centre, New Delhi, told News18 that “NAION typically affects one eye and is often associated with factors like hypertension, diabetes, and other vascular conditions.”
“Being the third highest ranking among journals, we cannot undermine the findings of JAMA which says that people who have been prescribed a weight loss drug (Semaglutide) could be at a higher risk of developing this eye condition.”
He added that “whether such condition is because of the drug or associated metabolic or cardiovascular changes (which happen after taking the drug) is still unknown”.
Gupta explained that “Semaglutide may contribute to NAION by causing blood flow changes or other vascular effects in the optic nerve”.
“We emphasise the importance of close monitoring and early detection, especially for patients taking Semaglutide, to prevent further damage and to identify potential treatment options.”
Similarly, the country’s top endocrinologists have emphasised monitoring the concern while adding that they haven’t noticed any such complaints in their clinical practice.
“It is an observational study, and similar findings have not been reported in randomised clinical trials. While this raises concerns for the medical community to monitor carefully, no such complaints have been noted by practitioners so far. Currently, the drug is prescribed by numerous doctors worldwide,” said Dr Ambrish Mithal, chairman and head, endocrinology and diabetes at Max Healthcare, Saket, New Delhi.
According to Dr Anoop Misra, chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences, “we need more data and better performed studies” for concrete findings. “In my experience of more than a thousand treated patients, no such cases were seen,” he said.
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