The rise of new weight-loss medications has offered hope to many, but a critical conversation is emerging in the medical community: What are the potential vision costs of these powerful drugs? Recent observations and studies are prompting doctors and patients to be aware of rare, yet serious, eye complications. A Troubling Pattern Emerges This is …
The rise of new weight-loss medications has offered hope to many, but a critical conversation is emerging in the medical community: What are the potential vision costs of these powerful drugs? Recent observations and studies are prompting doctors and patients to be aware of rare, yet serious, eye complications.
A Troubling Pattern Emerges
This is the first study linking semaglutide use to nonarteritic anterior ischemic optic neuropathy (NAION) – a type of stroke in the eye’s optic nerve.
Known Vision Risks Across Weight-Loss Drugs
It’s not entirely new for weight-loss medications to have vision-related side effects. Here’s a brief overview:
- GLP-1 Receptor Agonists (e.g., semaglutide, tirzepatide): Labels warn of an increased risk for diabetic retinopathy in patients with type 2 diabetes.
- Phentermine/Topiramate Combination: Risks include acute myopia (nearsightedness) and secondary angle-closure glaucoma (a sudden, painful increase in eye pressure).
- Naltrexone/Bupropion Combination: Lists the risk for angle-closure glaucoma.
All weight-loss drugs can potentially:
- Temporarily change the shape of the eye lens, causing blurred vision.
- Worsen diabetic retinopathy due to rapid blood sugar drops.
- Increase the risk for blindness from NAION.
A Shifting View on GLP-1 Receptor Agonists
Dr. Rizzo’s July 2024 study in JAMA Ophthalmology found that patients with type 2 diabetes or obesity taking semaglutide had a four to seven times higher risk for NAION. While this study had some limitations, it spurred further research, with conflicting results emerging from subsequent studies. The American Academy of Ophthalmology has emphasized the need for more research, advising patients not to stop semaglutide unless they experience sudden vision loss.
Interestingly, GLP-1 receptor agonists are also linked to other eye issues, like a twofold higher risk for neovascular age-related macular degeneration in diabetic patients taking these drugs. However, in patients with obesity but without diabetes, some studies suggest GLP-1 agents might actually be protective against conditions like primary open-angle glaucoma and ocular hypertension, compared to other weight-loss medications.
New Insights on Older Drugs
Phentermine, approved in 1959 and the most prescribed weight-loss drug in the US, is also under scrutiny. While it has been associated with blurred vision and serious ocular side effects (including NAION), a recent study found that phentermine was associated with a decreased future risk for a new diagnosis of diabetic retinopathy or the need for injections to treat it. This suggests a potential protective effect against a common diabetic eye complication.
Topiramate, often used in combination with phentermine, has raised concerns for angle-closure glaucoma. Analysis of the FDA database found topiramate was 30% more likely than semaglutide to be associated with reports of vision impairment (including blindness and reduced vision).
Making Informed Decisions
When choosing a weight-loss medication, healthcare providers like Dr. Cecil consider a patient’s existing eye health. However, insurance coverage and affordability often drive decisions. Despite potential eye risks, Dr. Cecil favors GLP-1s for most patients due to their overall safety and growing evidence of broad health benefits, including cardiovascular risk reduction.
Ultimately, given the complexity of chronic diseases like obesity and diabetes, individualized treatment plans are paramount. If you’re considering a weight-loss medication, it’s crucial to have a thorough discussion with your doctor about all potential benefits and risks, including those related to your vision.
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