Semaglutide Use in Diabetes: A Doubling Risk of Irreversible Vision Loss

Semaglutide, a once-weekly medication widely used to manage Type 2 diabetes (T2D), has proven benefits in controlling blood sugar and promoting weight loss. However, a recent study published in the International Journal of Retina and Vitreous highlights a significant concern: its use may double the risk of developing nonarteritic anterior ischemic optic neuropathy (NAION)—a condition leading to irreversible vision loss.

Understanding NAION and Its Impact on Vision

NAION is a serious condition characterized by sudden vision loss due to disrupted blood flow to the optic nerve. Once it occurs, the damage is often irreversible, making prevention critical, especially for patients already at increased risk due to underlying health conditions like diabetes.

The Study: Semaglutide and Vision Risk

A team of researchers, led by Jakob G., conducted a five-year longitudinal cohort study (2018–2024) in Denmark. The study aimed to evaluate the risk of NAION in T2D patients using semaglutide compared to those who were not.

Study Design:

Participants: 424,152 individuals with T2D.
Semaglutide Group: 106,454 patients who were prescribed semaglutide.
Non-Exposure Group: 317,698 patients without semaglutide use.
Data Observed: 1,915,120 person-years.

Key Findings

1. Incidence of NAION:

Semaglutide Users: 67 cases, with a median time of 22.2 months from first prescription to diagnosis.
Non-Users: 151 cases.

2. Incidence Rates:

Semaglutide Users: 0.228 per 1000 person-years.
Non-Users: 0.093 per 1000 person-years (p < 0.001).

3. Risk Assessment:

After accounting for multiple confounding factors, semaglutide use was found to independently predict a 2.19-fold higher risk of NAION (HR 2.19; 95% CI, 1.54–3.12).

These findings highlight a clear and concerning link between semaglutide use and an increased risk of irreversible vision loss.

Implications for Clinical Practice

While semaglutide remains an effective treatment for managing T2D, this study underscores the importance of individualized treatment plans.

Considerations for Clinicians:

Risk Assessment: Screen for pre-existing optic nerve conditions or other risk factors before initiating semaglutide.
Patient Education: Inform patients about potential symptoms of NAION, such as sudden vision changes, and stress the importance of immediate medical attention if they occur.
Alternative Treatments: Explore other options for patients with a higher risk of vision complications.

Tailoring treatment plans to minimize risks while optimizing diabetes management is critical.

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