| With Ozempic and other GLP-1 drugs skyrocketing in popularity for weight loss, new questions are surfacing: Could they affect your vision? To dig into this, I interviewed (via email) the research team behind a recent JAMA Ophthalmology study: Dr. Reut Shor, Dr. Marko Popovic, Dr. Rajeev Runi, and Dr. Andrew Mihalache. Their work looks specifically at individuals with Type 2 Diabetes, and they plan to expand their research to people without diabetes in the future. *This interview was FIRST published in my July Newsletter HERE! (Check that out for other articles and SUBSCRIBE to be first to know who is coming on the podcast next!) Interview on Ozempic Vision Side Effects: |
| Can you tell our readers a little about yourself and the work you do? What prompted you to investigate a potential link between the popular weight-loss drugs (GLP-1 receptor agonists) and the serious eye condition called wet macular degeneration (also known as Neovascular Age-Related Macular Degeneration or nAMD)? We are a group of physicians, researchers and methodologists who all have an interest in ocular (eye) health. Investigating the potential toxicities of systemic medications on retinal health is one of our areas of interest. Neovascular Age-Related Macular Degeneration (AMD) is fundamentally a disease of pathological angiogenesis (new blood vessel formation), and several of its risk factors overlap with those seen in patients who often use GLP-1 receptor agonists, such as those with chronic heart failure, chronic kidney disease, and diabetes. In addition, there have been growing reports of ocular adverse events with GLP-1 receptor agonists, but no clear consensus regarding their impact on AMD progression. This made me very curious to explore this relationship using real-world, population-level data. For those unfamiliar, can you describe what neurovascular age-related macular degeneration (nAMD) is and why it is significant for patients with diabetes (Type 2?) Age-related macular degeneration is a condition that affects the retina (which is similar to the film in a camera) at the back of the eye. It is the most common cause of vision loss in those aged 50 and older in the developed world. Age-related macular degeneration exists in two main forms: the early form called dry AMD, and the more advanced form called wet AMD or neovascular AMD (nAMD). In nAMD, abnormal blood vessels grow beneath the retina and leak, leading to rapid and potentially severe vision loss. This condition is particularly relevant for patients with type 2 diabetes, mainly because GLP-1 receptor agonists are commonly prescribed for diabetes management, but also because both diabetes and nAMD share key risk factors such as aging, impaired blood circulation, and chronic inflammation. Your study found a twofold increased risk of nAMD in patients with type 2 diabetes using GLP-1 Receptor Agonists (RAs). How clinically significant is this increase? How should patients and/or clinicians interpret it? While the absolute risk remains low—about 2 in 1,000 for GLP-1 RA users compared to 1 in 1,000 for non-users—the twofold increase in a matched population is clinically meaningful. It suggests a potential biological link between the medication and the disease. Additionally, older age and a history of stroke were both associated with an even higher risk of nAMD in the context of GLP-1 receptor agonist use. For these higher-risk patients, clinicians may want to exercise additional caution. Regardless of age or comorbidities, it’s important for clinicians to be aware of potential ocular risks and to promptly refer patients to ophthalmology if they report visual symptoms or concerns. Close collaboration between prescribing clinicians and eye care providers will be key as we continue to learn more. Do we know why GLP-1 RAs might be associated with increased risk of nAMD? Are there any working theories? GLP-1 receptor agonists appear to have several different adverse effects on the eye, and it seems that the net effect may be harmful in the context of neovascular AMD. On one hand, we know that GLP-1 receptor agonists are very effective at improving blood glucose control. Some studies have suggested that the increase in ocular adverse events could be related to the sudden and sharp drop in blood glucose upon initiating these agents. If this is true, we would hypothesize that after longer-term use, once blood sugar levels stabilize, the risk of nAMD with GLP-1 receptor agonist use might decline. However, in our study, we observed that the risk actually increased with prolonged exposure. When we looked further into the potential direct effects of GLP-1 receptor activation on the eye, we found that GLP-1 receptors are expressed in the retina, specifically, in the retinal ganglion cells, retinal pigment epithelial cells and endothelial cells, which may trigger different cascades. For example, an animal study in mice showed that activation of these receptors can induce a hypoxic effect on the retina. This could represent one possible mechanism contributing to the increased risk we observed.Of course, more research is needed to fully understand these pathways, but these findings offer some important clues. Are specific GLP-1 RAs more implicated than others or was the increased risk consistent across the class? 97.5% of the prescribed GLP-1 drugs in our study were semaglutide (Ozempic), while lixisenatide (Adlyxin) accounted for only 2.5% of prescriptions. This is likely because semaglutide was the more widely available and indicated formulation during the study period. Thus, the results reflect the overall class effect observed. To draw conclusions regarding specific GLP-1 agents, more granular data would be required in future studies. These drugs are widely used for diabetes and weight loss. In your opinion, how should this finding influence prescribing decisions, if at all, education for patients or label warnings? I wouldn’t say it should cause alarm, but it should encourage awareness. GLP-1 receptor agonists provide significant benefits for cardiovascular and kidney outcomes, and those benefits remain very important. However, patients, especially those at higher risk for AMD (such as older adults or those with a history of stroke), should be monitored carefully, and clinicians should remain vigilant for any new visual symptoms in these patients. Patients who are prescribed these drugs that experience vision issues should be promptly referred to an ophthalmologist for further evaluation. What kind of follow-up studies are needed to understand this risk more clearly? (In those with diabetes, but I’m also curious about risk in those with obesity without diabetes.) The next steps for this research involve moving beyond observational findings to more definitive study designs. To establish causality, prospective cohort studies will be needed to confirm the association between GLP-1 receptor agonist use and neovascular AMD. In parallel, further investigation into the underlying biological mechanisms, through both basic science and translational research, will be essential to understand how these drugs may influence retinal health. Finally, as GLP-1 RAs are increasingly prescribed to non-diabetic individuals for weight loss, it will be important to study these populations as well, to determine whether the observed ocular risks extend beyond diabetic patients. Are you doing any more research in this area or what sort of research are you doing next, if any? Our next step will be to explore whether similar ocular risks are present in non-diabetic individuals, particularly given the growing use of GLP-1 receptor agonists for weight loss. To read the full study and learn more about the study authors, click here. Thanks for reading this interview on Ozempic vision side effects! :) Other stuff to check out in the blog: Credentialism: The Religion, The Rebellion, The Receipts Skip is Dead. What Killed Him? New Podcasts to check out: Can you keep your brain from aging? With Dr. Dale Bredesen Does this combination Really reduce your biological age? You can contact Dr. Eeks at bloomingwellness.com. Follow Eeks on Instagram here. Or Facebook here. Or X. On Youtube. Or TikTok. SUBSCRIBE to her monthly newsletter here! (Now featuring interviews with top experts on health you care about!) |
John Schwarzkopf jr
Great Article, as I was working out I read your article because I know folks that are doing this and I told them this shit is no good and said lose it the old fashion way, “”” reply “”” that’s to much work !!! I said my god ok but you’ll regret it
Dr. Eeks
Thanks John!
Send them this to read at least! :)
Eeks