Table of Contents
Introduction
Semaglutide is a medicine that has changed the way many people manage their health. It belongs to a group of medicines called GLP-1 receptor agonists, which help the body control blood sugar and reduce appetite. Doctors prescribe semaglutide most often for people with type 2 diabetes, but it has also become widely known as a treatment for weight management. In recent years, it has been in the spotlight because of its powerful effects on weight loss, leading to brand names like Ozempic and Wegovy becoming household terms. But along with its benefits, questions have grown about possible side effects. One of the biggest questions raised in the medical community and by patients is whether semaglutide can affect the eyes.
This concern is not random. People with diabetes already face a higher risk of eye disease, especially diabetic retinopathy. Diabetic retinopathy is a condition that damages the tiny blood vessels in the back of the eye, called the retina. Over time, this damage can cause vision changes and even blindness if not managed properly. Since semaglutide is designed to lower blood sugar, researchers have wondered if the way it works might influence retinopathy—sometimes making it better, but in other cases possibly making it worse, especially when blood sugar levels change quickly.
A major study published in JAMA Ophthalmology drew attention to this question. The study investigated whether there is a connection between semaglutide use and worsening of diabetic eye disease. For many patients, this study raised new concerns: Could the medicine that helps manage blood sugar and reduce weight also harm vision? Could the benefits of semaglutide come with hidden risks for the eyes? These are not simple questions, and that is why this article will take a deep dive into the study and its findings.
Understanding the possible effects of semaglutide on eye health matters for several reasons. First, diabetes and obesity—two main conditions treated with semaglutide—are both already linked with higher chances of vision problems. Second, vision loss has a big impact on quality of life. It affects independence, safety, and daily functioning. Patients who take semaglutide want to know not only how it helps with their blood sugar or weight, but also how it might affect their eyes both in the short term and long term.
The purpose of this article is to explain, in clear and straightforward language, what the JAMA Ophthalmology study found and why it matters. We will look at the study’s design, who was included, what the results showed, and how doctors are responding. We will also discuss possible reasons why semaglutide may be linked to changes in eye health, and who might be most at risk. By going step by step, this article will help patients, families, and healthcare providers better understand the connection between semaglutide and vision.
It is important to note that research is still developing. The JAMA Ophthalmology study adds to what we know, but it does not give all the answers. Medicine is complex, and no single study can provide complete certainty. That is why this article does not aim to create fear or overstate risk. Instead, the goal is to provide balanced information that can help people have more informed conversations with their doctors.
Eye health is a key part of overall health for anyone living with diabetes or using semaglutide. Regular eye exams, careful monitoring, and open communication with healthcare teams are all vital. At the same time, semaglutide offers major benefits for blood sugar control and weight management, both of which can reduce the risk of other complications. This creates a balance that doctors and patients must consider together: how to get the benefits of semaglutide while reducing the chances of eye-related side effects.
In the sections that follow, we will explore the most common questions people search for about semaglutide and the JAMA Ophthalmology study. We will explain what semaglutide is, why eyesight is already a concern for many patients, what the study found, and what can be done to protect eye health while taking this medicine. By the end, you will have a clearer picture of how semaglutide may affect vision, what risks exist, and what steps you and your healthcare team can take to stay safe.
What Is Semaglutide and Why Is It Prescribed?
Semaglutide is a medicine that doctors use to help people manage two common health problems: type 2 diabetes and obesity. These two conditions often go hand in hand, and both can cause serious health issues if not controlled. To understand why semaglutide is important, it helps to know how it works inside the body, what it is approved to treat, and why both patients and doctors are paying close attention to its possible side effects.
How Semaglutide Works in the Body
Semaglutide belongs to a class of medicines called GLP-1 receptor agonists. GLP-1 stands for glucagon-like peptide-1. This is a natural hormone that your body makes in the gut after you eat. GLP-1 helps control blood sugar by:
- Increasing insulin release: Insulin is the hormone that lowers blood sugar by helping it move from the blood into the body’s cells, where it can be used for energy.
- Decreasing glucagon release: Glucagon is a hormone that raises blood sugar by telling the liver to release stored glucose. By lowering glucagon, GLP-1 helps keep sugar levels steady.
- Slowing down digestion: GLP-1 slows the emptying of food from the stomach into the small intestine. This helps prevent sharp spikes in blood sugar after meals.
- Reducing appetite: GLP-1 acts on the brain to make people feel full sooner, which can reduce calorie intake.
Semaglutide copies the action of GLP-1 in the body, but it lasts longer and works more powerfully than the natural hormone. Because of this, it is very effective at lowering blood sugar and helping with weight loss.
Approved Uses of Semaglutide
Semaglutide is approved by the U.S. Food and Drug Administration (FDA) and other health agencies worldwide for two main purposes:
- Type 2 Diabetes
- First approved in 2017 under the brand name Ozempic.
- Helps people with type 2 diabetes lower their blood sugar levels.
- Can also lower the risk of serious heart problems, such as heart attack and stroke, in people with both type 2 diabetes and heart disease.
- First approved in 2017 under the brand name Ozempic.
- Obesity and Weight Management
- Approved in 2021 under the brand name Wegovy.
- Used in adults who are overweight or obese, especially if they also have weight-related health problems like high blood pressure, sleep apnea, or high cholesterol.
- Helps with long-term weight management when combined with healthy eating and physical activity.
- Approved in 2021 under the brand name Wegovy.
In both cases, semaglutide is usually given as a weekly injection under the skin. A pill version, called Rybelsus, is also available for type 2 diabetes, though it is less common than the injectable forms.
Why Patients and Doctors Are Interested in Side Effects
Semaglutide is considered one of the most effective medicines for diabetes and obesity today. People taking it often see major improvements in blood sugar control and weight loss compared with other treatments. Because of these strong results, it has become very popular in a short time.
But with strong benefits also come important questions. Patients and doctors want to know about possible risks and side effects. Some of the most common side effects include:
- Nausea and vomiting
- Diarrhea or constipation
- Stomach pain
Most of these are related to how semaglutide slows digestion. They are usually mild to moderate and often improve after the body adjusts. However, there are also less common but more serious risks that doctors must watch for, such as:
- Inflammation of the pancreas (pancreatitis)
- Gallbladder problems
- Possible increased risk of thyroid tumors (seen in animals, not yet proven in humans)
And now, based on recent research such as the JAMA Ophthalmology study, there is growing concern that semaglutide may affect eye health in some people—especially those who already have diabetic eye disease. This is why medical experts are studying semaglutide closely and updating their advice as new data comes out.
Why This Matters for Patients
For someone with type 2 diabetes, controlling blood sugar is extremely important. High blood sugar over time can damage the eyes, kidneys, heart, and nerves. Semaglutide helps lower blood sugar and reduces many of these risks. At the same time, losing weight can also improve overall health, lower blood pressure, and make diabetes easier to control.
Because of these benefits, doctors often see semaglutide as a powerful tool for patients who need better control of their diabetes or who struggle with obesity. However, doctors also balance these benefits with the possibility of side effects, including the new questions about eye health. This is why it is important for patients to have regular check-ups, eye exams, and ongoing conversations with their healthcare team while using semaglutide.
Semaglutide is a modern medicine that works by copying a natural hormone in the body to control blood sugar and reduce appetite. It is prescribed for type 2 diabetes and weight management and is available under the names Ozempic, Wegovy, and Rybelsus. While it is very effective, patients and doctors remain cautious because of both common digestive side effects and newer concerns, such as possible risks to eye health. These concerns are especially important for people with diabetes, since they may already have eye problems related to their condition.
Background: Why Eyesight Is a Concern in Diabetes and Obesity
When we think about diabetes or obesity, many people focus on blood sugar numbers, body weight, or heart health. But another area often affected is vision. The eyes are very sensitive to changes in blood sugar and blood flow. Because of this, people with diabetes or those living with obesity are at a higher risk for certain eye problems. Understanding this background is important before we look at how semaglutide, a medicine used for diabetes and weight management, may influence vision.
Diabetes and the Eyes: A Close Relationship
Diabetes can damage small blood vessels throughout the body. These vessels carry oxygen and nutrients to tissues, including the delicate structures inside the eye. The retina, which is the light-sensitive layer at the back of the eye, depends on a steady blood supply to work well.
When blood sugar levels stay too high for a long time, it can harm these vessels. They may become weak, leak fluid, or close off. Over time, new but fragile vessels may grow in response. This process is called diabetic retinopathy. It is one of the most common causes of vision loss in adults with diabetes.
Other eye conditions linked to diabetes include:
- Diabetic macular edema (DME): Swelling in the central part of the retina, which can blur vision.
- Cataracts: Clouding of the lens, which can happen earlier and more often in people with diabetes.
- Glaucoma: Damage to the optic nerve, sometimes related to changes in eye pressure, which is more common in diabetes.
These conditions can appear slowly and may not cause pain. That is why regular eye exams are essential for people with diabetes, even if they think their vision is fine.
The Role of Blood Sugar Swings
It is not only long-term high blood sugar that can affect vision. Rapid changes in glucose levels can also be harmful. If blood sugar rises or drops too quickly, the eye tissues may swell or shift, which can cause blurred or fluctuating vision.
When people start treatment that lowers blood sugar very effectively—such as insulin or newer medications like semaglutide—there may be a short-term worsening of retinopathy. This does not mean the medicine is bad, but it shows how sensitive the eyes are to sudden changes. Over the long term, good blood sugar control usually protects the eyes, but the transition period can be risky for some patients.
Obesity and Its Effects on Eye Health
Obesity by itself is also linked to eye problems. Carrying excess weight increases the risk for conditions like high blood pressure and high cholesterol. These conditions put extra strain on blood vessels, including those in the eyes.
Some studies suggest that obesity is connected to higher risks of age-related macular degeneration (AMD), cataracts, and glaucoma. The reasons are complex but may include:
- Inflammation: Extra body fat can trigger chronic low-level inflammation that affects many organs, including the eyes.
- Oxidative stress: Imbalance between free radicals and antioxidants in the body, which can damage eye tissues.
- Poor circulation: Obesity can slow blood flow, reducing oxygen supply to sensitive tissues like the retina.
Historical Context: Medications and Retinopathy
Concerns about diabetes medications and eye health are not new. In earlier decades, some clinical trials showed that people who experienced rapid drops in blood sugar after starting insulin were more likely to see a temporary worsening of diabetic retinopathy. Over time, though, the benefits of long-term blood sugar control became clear.
Because of these past findings, researchers have paid close attention to how new medicines affect the eyes. Semaglutide is very effective at lowering blood sugar and supporting weight loss, which makes it powerful. But with that power comes the need to watch closely for eye-related side effects, especially in patients who already have retinopathy.
For someone living with diabetes or obesity, vision problems can affect daily life more than many other complications. Reading, driving, working, and even recognizing faces depend on healthy eyes. Unlike some health issues that can remain “silent” for years, vision changes are noticeable and can be frightening.
Understanding the link between diabetes, obesity, and eye health helps patients and doctors prepare. It explains why studies, like the one in JAMA Ophthalmology, are so important. These studies help identify risks early, so patients can be monitored and treated before problems lead to permanent vision loss.
What Was the JAMA Ophthalmology Study About?
When doctors prescribe a new medicine, they want to know not only how well it works but also what side effects it may cause. Semaglutide has been shown to lower blood sugar and help with weight loss. But like many medicines for diabetes, doctors need to know if it has any effects on the eyes. This is especially important because people with diabetes are already at risk for eye problems. The JAMA Ophthalmology study was designed to look closely at this possible link.
The Goal of the Study
The main goal of the study was to see if semaglutide changes the risk of eye problems, especially diabetic retinopathy. Diabetic retinopathy is an eye disease caused by damage to the blood vessels in the retina. It can cause blurry vision, floaters, or even blindness if it gets worse. Researchers wanted to know: Does semaglutide make this condition better, worse, or not change it at all?
The study did not focus only on new cases of eye disease. Instead, it looked at patients who already had diabetes and asked whether starting semaglutide might make their existing eye problems worse.
Who Was Studied
The study included adults with type 2 diabetes. Many of them had been living with diabetes for years. Some already had signs of diabetic retinopathy before the study started, while others did not. This was important, because people with existing eye disease may react differently to a drug compared to those with healthy eyes.
Patients in the study were treated with either semaglutide or another therapy. By comparing these two groups, researchers could measure whether eye complications happened more often in people taking semaglutide.
The Design of the Study
The research was structured as part of a larger clinical trial program. These trials were designed to test the safety and effectiveness of semaglutide in people with type 2 diabetes.
The eye-focused part of the study was not a separate trial but an analysis of data collected during those larger trials. Researchers went back through the information and paid special attention to reports about eye problems.
In medical research, this is called a “secondary analysis.” It means that the main goal of the original trial was to test blood sugar control and heart safety. But the data was later re-examined to answer new questions, such as how the drug might affect the eyes.
What Outcomes Were Measured
Researchers measured a range of outcomes related to eye health. These included:
- Progression of diabetic retinopathy: Did the condition get worse in people who already had it?
- Development of new retinopathy: Did people without retinopathy develop it after starting semaglutide?
- Need for medical or surgical eye treatment: For example, laser therapy, injections into the eye, or surgery for bleeding in the retina.
- Changes in vision: Whether patients reported worsening eyesight.
By looking at these outcomes, the researchers could form a more complete picture of how semaglutide might influence eye health.
Publication in JAMA Ophthalmology
The findings were published in JAMA Ophthalmology, a respected peer-reviewed medical journal. Peer-reviewed means that other experts in the field read the study carefully before it was published, checking the methods and results for accuracy. This makes the study more trustworthy compared to information that is not reviewed.
The journal focuses on new research in vision and eye health. Publishing the analysis there helped doctors, eye specialists, and researchers quickly learn about the possible link between semaglutide and eye risks.
Why This Study Matters
This study matters because it highlighted a possible safety issue that was not fully understood before. Semaglutide helps many people lower their blood sugar and reduce their weight, which are both important for long-term health. But if the medicine also increases the risk of eye complications, doctors and patients need to know this early.
It is especially important because diabetic retinopathy is already one of the leading causes of blindness among adults with diabetes. Any medicine that might speed up or worsen this condition needs careful study.
What Makes This Study Unique
Several features made this study stand out:
- Large patient population: The analysis used data from many people across multiple clinical trials.
- Focus on complications: It did not just look at whether retinopathy was present, but whether it became severe enough to need treatment.
- Connection to blood sugar changes: The study raised questions about whether rapid drops in blood sugar, which are common when semaglutide is very effective, may play a role in worsening retinopathy.
The JAMA Ophthalmology study was not the final word on semaglutide and the eyes, but it was an important early warning sign. It showed that there may be a link between semaglutide and worsening eye disease in certain patients. It also pushed researchers to ask more questions: Who is most at risk? Is the problem temporary or long-term? And how should doctors monitor their patients to prevent harm?
What Did the Study Find About Semaglutide and the Eyes?
The JAMA Ophthalmology study raised important questions about how semaglutide may affect vision, especially in people who already have diabetes-related eye disease. The research did not say that everyone who takes semaglutide will have eye problems, but it did show a link between semaglutide and an increased chance of eye complications in some patients. Below, we will look closely at what the researchers found and what those findings mean in practice.
The Main Findings
The study reported that people taking semaglutide had a higher rate of eye-related problems compared to those who were not on the medication. The main concern was diabetic retinopathy complications. Diabetic retinopathy is an eye condition caused by damage to the blood vessels in the retina, the thin layer of tissue at the back of the eye that helps us see. If the condition worsens, it can lead to blurry vision, blind spots, or even permanent vision loss.
The researchers saw that some patients on semaglutide developed new or worsening retinopathy issues. These included:
- Increased swelling in the retina (known as macular edema).
- Bleeding inside the eye from fragile blood vessels.
- A need for laser treatment or surgery to stop bleeding or repair damaged blood vessels.
How Strong Was the Association?
The study found a clear link, but it is important to understand what “increased risk” means. The researchers measured the percentage of people who developed serious eye problems over time. The numbers showed that:
- A small but noticeable group of patients on semaglutide developed worsening retinopathy compared to those not on the drug.
- The risk was not the same for everyone. It was highest in patients who already had moderate to severe retinopathy before starting semaglutide.
- Patients with little or no existing eye disease had a much lower chance of new problems.
In other words, the medication seemed to speed up or bring forward eye issues in people who were already at risk.
What Do the Numbers Mean for Patients?
The actual number of patients who developed severe eye issues was relatively low, but the difference between semaglutide users and non-users was enough to matter. To put it simply:
- If you already have eye disease from diabetes, your chance of worsening retinopathy is higher if you start semaglutide.
- If your eyes are healthy or you have very mild retinopathy, the risk is much smaller.
This is why doctors often stress the importance of regular eye exams, especially in the first year of treatment.
Timing of Eye Problems
Another important point from the study is when eye problems appeared. Most complications happened within the first year after starting semaglutide. This timing suggests that the drug itself may not directly damage the eye, but that rapid changes in blood sugar levels may trigger problems.
Many patients on semaglutide see a fast drop in blood sugar and weight. While this is good for overall health, a sudden improvement in blood sugar can sometimes worsen existing retinopathy in the short term. This is a well-known effect that has been seen with other diabetes treatments too.
Does This Mean Everyone Is at Risk?
No, the study does not suggest that every patient taking semaglutide will face eye complications. Instead, it highlights which groups of patients need closer watching. These include:
- People with long-standing diabetes.
- People with moderate or severe diabetic retinopathy at baseline.
- People whose blood sugar levels drop very quickly after starting the drug.
For most other patients, semaglutide remains safe and effective, but the study adds a reminder that eye health must be part of treatment planning.
The findings are important because semaglutide is widely used and often very effective at lowering blood sugar and helping with weight loss. Both of these outcomes reduce the risk of heart disease, kidney problems, and long-term complications of diabetes. However, the possible short-term risk to vision means that doctors must balance benefits and risks carefully.
Patients who are told about this study may feel worried, but the results also show that with good monitoring, risks can be managed. Many patients can continue taking semaglutide while protecting their eye health through regular eye exams and prompt treatment of any early vision changes.
The JAMA Ophthalmology study found that semaglutide may increase the risk of diabetic retinopathy complications, especially in patients who already have eye disease. The risk seems to be greatest in the first year of treatment, likely because of how quickly blood sugar improves. While the overall number of affected patients is relatively small, the findings remind us that diabetes care should include both blood sugar management and eye health monitoring.
Why Might Semaglutide Affect Vision?
The JAMA Ophthalmology study raised important questions about why semaglutide, a drug that helps with diabetes and weight loss, may affect the eyes. The study showed that people taking semaglutide, especially those with diabetes, had a higher chance of eye problems such as worsening diabetic retinopathy. But the study did not prove the drug directly harms the eyes. Instead, researchers believe there are several possible reasons why this link was seen. In this section, we will explore these reasons in detail.
Rapid Blood Sugar Improvement
One of the strongest theories is that semaglutide lowers blood sugar very quickly, sometimes faster than the body can adjust. When a person with diabetes has high blood sugar for a long time, the tiny blood vessels in the eyes become fragile. If blood sugar suddenly drops, these fragile vessels can react in harmful ways.
Doctors have known about this effect for years. It has been seen with other diabetes treatments, such as insulin. When blood sugar improves too quickly, it can sometimes trigger “early worsening” of diabetic retinopathy. This means that eye damage may look worse at first, even though long-term blood sugar control usually protects the eyes.
With semaglutide, this effect may happen because the drug is very effective. In clinical trials, many patients experienced a big drop in HbA1c (a measure of average blood sugar). This large and rapid change could explain why some patients developed more severe eye problems soon after starting treatment.
Changes in the Retina’s Blood Vessels
Another possible explanation is related to how blood flows in the retina, the thin layer of tissue at the back of the eye that allows us to see. The retina depends on a steady blood supply. In diabetes, this supply is often damaged because blood vessels leak or close off.
When semaglutide improves blood sugar, blood flow in the retina may change quickly. This can place stress on weak or already damaged vessels. Some researchers think this stress could lead to bleeding, swelling, or sudden worsening of existing retinopathy.
While semaglutide does not directly attack the retina, its strong effect on metabolism might indirectly affect these delicate blood vessels. More research is needed to fully understand this process.
Impact on Existing Diabetic Retinopathy
The JAMA Ophthalmology study suggested that patients who already had diabetic retinopathy at the start of treatment were the most likely to see worsening eye problems. This makes sense because their eyes were already fragile.
If someone has mild retinopathy, even a small change in blood sugar levels can tip the balance and make the condition worse. On the other hand, patients without any signs of retinopathy seemed to have a lower risk. This shows that the drug itself may not be harmful to healthy eyes but can add stress to eyes already under strain from diabetes.
This finding highlights why eye screening is so important before starting semaglutide. Knowing whether retinopathy is already present can help doctors monitor patients more closely.
Possible Direct Effects on the Eye
Some scientists wonder if semaglutide could act directly on the eye. This idea comes from the fact that the body has GLP-1 receptors, the same receptors semaglutide targets. These receptors have been found in many tissues, and there is some evidence they may also exist in the retina.
If this is true, semaglutide might have local effects in the eye that we do not fully understand yet. However, current evidence is weak, and most researchers believe that indirect effects—such as rapid blood sugar changes—are the main explanation. Still, this is an area that deserves more study.
What Is Known vs. Still Unclear
At this stage, scientists know that:
- People with diabetes who start semaglutide may see worsening of retinopathy.
- Rapid drops in blood sugar are a likely cause.
- Patients with existing retinopathy are most at risk.
But many things are still unclear:
- Does semaglutide cause long-term eye damage, or is the effect only temporary?
- Would a slower dose increase reduce the risk?
- Are some patients genetically more sensitive to these changes?
Until more studies are done, these questions remain unanswered.
Semaglutide probably does not “attack” the eye directly. Instead, the drug lowers blood sugar so effectively that it may put stress on fragile eye vessels in patients with diabetes. Rapid improvements in glucose, changes in retinal blood flow, and pre-existing diabetic retinopathy all seem to play a role. While these ideas explain why eye complications were seen in the JAMA Ophthalmology study, researchers agree that more work is needed to confirm the exact mechanisms.
For patients, the key lesson is that eye health and blood sugar control are closely linked. Anyone starting semaglutide should work closely with both their doctor and eye specialist, especially if they already have signs of diabetic retinopathy.
Who Is Most at Risk According to the Study?
The JAMA Ophthalmology study looked closely at which patients taking semaglutide were more likely to develop eye complications. The findings showed that not everyone faces the same level of risk. Instead, certain groups of people seem to be more vulnerable. Understanding who is most at risk can help doctors and patients make safer choices about treatment and monitoring.
Patients With Pre-Existing Diabetic Eye Disease
One of the clearest findings from the study was that people who already had diabetic retinopathy before starting semaglutide faced the highest risk of worsening eye problems.
- Diabetic retinopathy is a condition where high blood sugar damages the small blood vessels in the retina, the part of the eye that senses light.
- In its early stages, it may cause few or no symptoms. But as it progresses, it can lead to swelling, bleeding, scarring, and even blindness.
For patients with some level of retinopathy already present, the study found that semaglutide could make the condition worse in the short term. This does not mean semaglutide directly damages the eye. Instead, it may be related to how quickly blood sugar levels drop after starting treatment.
This “early worsening” phenomenon has been seen with other diabetes drugs in the past, not only semaglutide. When blood sugar improves very quickly, the fragile blood vessels in the retina may not adapt well, leading to a temporary increase in eye damage.
Patients With Very High Blood Sugar Levels Before Starting Semaglutide
Another group that seems more at risk is people who had very high blood sugar levels before they began semaglutide.
- If someone’s blood sugar has been poorly controlled for a long time, their eyes and blood vessels have adapted to that high-glucose environment.
- When semaglutide brings blood sugar down quickly, this sudden change can put stress on the retina.
The study suggested that the rate of improvement in blood sugar is an important factor. The faster the drop, the greater the risk of short-term worsening of diabetic retinopathy.
This is why many experts recommend gradual control of blood sugar whenever possible. A steady improvement over time is easier for the body and the eyes to handle compared with a rapid shift.
Patients With Long-Standing Diabetes
The longer someone has lived with diabetes, the more likely they are to already have hidden or advanced complications.
- Long-term diabetes increases the risk of both mild and severe diabetic retinopathy.
- Even if someone does not yet have obvious vision problems, small changes may already be happening inside the retina.
For these patients, semaglutide can be very effective in lowering blood sugar and protecting the heart and kidneys. But at the same time, it may “unmask” or worsen existing eye disease. This makes careful eye exams especially important for people who have had diabetes for many years.
The Role of Rapid Blood Sugar Reduction
The JAMA Ophthalmology study, along with earlier diabetes research, points to rapid blood sugar reduction as a key factor.
- If blood sugar falls slowly, the eye’s blood vessels have more time to adjust.
- If it drops quickly, the stress on the retina is greater.
Think of it like adjusting to a sudden change in light: if the lights in a room dim slowly, your eyes can adapt without strain. But if they go dark in an instant, your vision struggles. The retina reacts in a similar way when faced with sudden blood sugar changes.
This does not mean that lowering blood sugar is harmful overall. In fact, long-term control is the best way to prevent serious eye disease. The problem is mainly in the short-term adjustment period.
Patients With Poor Access to Regular Eye Care
Another important risk factor is lack of regular eye exams. Patients who do not get their eyes checked may miss the early signs of retinopathy or worsening disease.
- The study highlights that patients starting semaglutide should ideally have a baseline eye exam.
- Follow-up visits allow doctors to catch small changes before they become serious.
Without this monitoring, people at risk may not realize their vision is being affected until damage is harder to treat.
What This Means for Patients and Doctors
Knowing who is most at risk helps guide safe treatment. Doctors can:
- Recommend an eye exam before starting semaglutide.
- Monitor patients closely in the first year of treatment.
- Adjust treatment pace if needed to avoid too-rapid blood sugar reductions.
Patients can play their part by:
- Reporting any vision changes, such as blurred vision, floaters, or sudden dark spots.
- Attending all recommended eye exams.
- Talking with both their endocrinologist and ophthalmologist about their treatment plan.
By paying attention to these risk factors, patients can get the benefits of semaglutide while lowering the chance of eye complications.
How Do These Findings Compare With Other Studies?
When the JAMA Ophthalmology study suggested that semaglutide might increase the risk of eye complications such as diabetic retinopathy, it raised many questions. People wanted to know if this finding was unique to that study or if other research showed the same results. To understand this better, we need to compare the JAMA Ophthalmology study with other clinical trials and reviews that looked at semaglutide and eye health.
Semaglutide in Large Diabetes Trials
The most well-known trial that studied semaglutide is called SUSTAIN-6. This was a cardiovascular outcomes trial, meaning it was designed to see if semaglutide affected heart health in people with type 2 diabetes. While the main focus was not the eyes, researchers did collect data about diabetic retinopathy.
- What SUSTAIN-6 found: Patients taking semaglutide had a higher rate of complications from diabetic retinopathy compared with patients on placebo. These complications included worsening vision, the need for laser therapy, and in some cases surgery to repair the retina.
- Why this mattered: The trial showed the problem was not limited to the JAMA Ophthalmology study. It hinted at a pattern that semaglutide, especially in people with existing diabetic eye disease, might trigger worsening symptoms.
This finding from SUSTAIN-6 lined up with the concerns raised in the JAMA Ophthalmology study, which means the signal is consistent across different groups of patients.
Other GLP-1 Receptor Agonists and Eye Health
Semaglutide is not the only GLP-1 receptor agonist. Other medicines in the same family include liraglutide, dulaglutide, and exenatide. Several studies have looked at whether these drugs affect eye health.
- Mixed results: Some trials with other GLP-1 drugs did not show the same increase in retinopathy complications. For example, trials of liraglutide did not find a strong connection to worsening eye disease.
- Possible reasons: One explanation is that semaglutide is stronger and lowers blood sugar faster than other GLP-1 drugs. Rapid improvement in blood sugar has long been known to sometimes make diabetic retinopathy worse in the short term, even though good glucose control is beneficial in the long run.
This difference between semaglutide and its relatives is important. It suggests that the issue may not be the entire drug class, but rather how semaglutide works in a powerful and fast-acting way.
Meta-Analyses and Systematic Reviews
Researchers have also looked at many trials together in reviews called meta-analyses. These studies try to combine data from different trials to see overall patterns.
- What they found: Most meta-analyses agree that semaglutide may increase the risk of early worsening of diabetic retinopathy in people who already have the disease. However, they also note that the overall number of cases is not very large.
- Uncertainties remain: Some reviews argue that the evidence is not strong enough to say for certain that semaglutide directly causes eye problems. They point out that patients in these studies often had long-standing diabetes, high blood sugar levels at the start, and were already at high risk for retinopathy.
This means the effect may be more about who is taking the drug and how fast their blood sugar improves, rather than the drug itself damaging the eyes.
Long-Term Outcomes
One of the most important questions is what happens in the long run. Diabetes specialists know that tight blood sugar control helps protect the eyes over time. The concern is mainly about the first months of therapy, when blood sugar drops quickly.
- Short-term vs. long-term: The available data suggest that retinopathy may worsen soon after starting semaglutide, but long-term benefits of better glucose control are still expected. If blood sugar is managed well, patients may have fewer complications years later.
- Follow-up studies: Longer studies are underway to see if the early worsening effect is temporary or if it continues to be a problem. Early signs suggest it may be temporary, but more time and data are needed.
Where Research Is Consistent
Across most studies, a few points are consistent:
- People with no diabetic retinopathy at baseline are less likely to have problems when starting semaglutide.
- People with advanced retinopathy or very high blood sugar at the beginning are more at risk.
- Rapid drops in glucose are linked with eye changes, regardless of the drug used.
Where Research Is Mixed
There are still areas of debate:
- Not every trial has shown an increase in retinopathy with semaglutide.
- The size of the risk varies from study to study.
- Researchers disagree on whether the drug itself is harmful to the retina or if the effect is due to fast glucose lowering.
When comparing the JAMA Ophthalmology study to other research, the evidence points to a real but complex risk. The link between semaglutide and worsening diabetic retinopathy is strongest in people who already have eye disease and whose blood sugar drops quickly. Other studies back up this concern, but they also show that the long-term benefits of better diabetes control remain important. For now, the best conclusion is that semaglutide can affect eye health in certain patients, but careful monitoring and gradual glucose control may reduce the risk.
Should Patients Stop or Avoid Semaglutide Because of Eye Risks?
When people hear that a medicine could affect their eyes, the first thought is often: “Should I stop taking it?” This is a natural concern, especially when the medicine in question, semaglutide, is one of the most talked-about treatments for diabetes and weight management. To answer this, it is important to look at the balance between the benefits of semaglutide and the possible risks to vision.
The Benefits of Semaglutide
Semaglutide is not a minor medicine. For many patients, it can be life-changing. It works by mimicking a hormone in the body called GLP-1 (glucagon-like peptide-1). This helps lower blood sugar levels, improves insulin use, and can also reduce appetite, which leads to weight loss.
For people with type 2 diabetes, lowering blood sugar reduces the risk of long-term problems such as heart disease, kidney failure, and nerve damage. For people with obesity, losing weight can reduce pressure on the heart, lower blood pressure, and improve overall health.
Because of these strong benefits, doctors often consider semaglutide one of the most effective modern treatments.
What the Study Said About Eye Risks
The JAMA Ophthalmology study raised a specific concern: patients with diabetes who already had eye problems, especially diabetic retinopathy, might face a higher risk of worsening vision when starting semaglutide.
This does not mean that everyone who takes semaglutide will develop eye disease. Instead, the study found that in people with existing eye damage, the medicine may speed up changes in the retina, especially if blood sugar levels drop very quickly.
The main point is that the risk seems to be focused on a particular group—patients with diabetes and advanced or long-standing eye disease.
Balancing Risks and Benefits
Doctors do not want patients to stop semaglutide without careful thought. For many people, the benefits to blood sugar control, weight, and heart health outweigh the possible risks to vision. However, the balance may look different for someone with severe diabetic eye disease compared to someone with no eye problems.
Stopping semaglutide suddenly can cause blood sugar levels to rise again, which itself may worsen diabetic eye disease over time. Poorly controlled diabetes is one of the strongest causes of blindness. This means that not taking the medicine could also harm the eyes, but in a slower and less obvious way.
How Doctors Are Approaching Prescriptions
Most medical guidelines do not say to avoid semaglutide completely. Instead, doctors are advised to:
- Check the eyes before starting treatment. An eye exam can show if there are signs of retinopathy or other damage.
- Monitor vision during treatment. Patients may be asked to report any changes in sight, such as blurry vision, dark spots, or flashes of light.
- Adjust the pace of glucose lowering if possible. Rapid drops in blood sugar may trigger eye changes, so doctors may try to lower levels more slowly.
- Work with an eye specialist. For patients with known diabetic eye disease, an ophthalmologist may check their eyes more often during the first year of semaglutide treatment.
These steps do not remove the risk completely, but they help manage it.
Importance of Individualized Care
Every patient’s situation is unique. Some may have mild diabetes and no eye damage. For them, the benefit of semaglutide is high, and the eye risk is low. Others may have long-standing diabetes with fragile blood vessels in the eyes. For them, the risk is higher, but it may still be worth it if blood sugar control is critical.
Doctors make decisions based on the whole picture: age, diabetes history, eye health, heart risk, weight, and personal goals. This is why two patients may receive different advice about the same medicine.
The Role of Patient Awareness
Patients should not stop semaglutide on their own because of what they read online. Instead, the best step is to talk with both the prescribing doctor and an eye specialist. Open communication helps balance the risks and benefits safely.
Simple steps can also help patients take control:
- Get regular eye exams.
- Tell the doctor right away about any vision changes.
- Follow the treatment plan for diabetes, including healthy eating, exercise, and other medications.
The JAMA Ophthalmology study does not mean semaglutide is unsafe for the eyes in all people. Instead, it highlights a need for careful monitoring, especially in those who already have diabetic retinopathy. For most patients, the benefits of better blood sugar control and reduced weight are very large.
Doctors generally recommend continuing treatment but with more attention to eye health. Patients should see the study as a reminder to protect their vision, not as a reason to stop treatment on their own.
What Can Patients Do to Protect Their Eye Health While on Semaglutide?
When people start taking semaglutide, one of the biggest questions is how they can keep their eyes safe. This is especially important for people with diabetes, because diabetes itself already increases the risk of eye disease. The JAMA Ophthalmology study raised concerns about worsening eye problems in some patients. But the good news is that there are practical steps patients can take to protect their vision while still benefiting from semaglutide. These steps include regular eye exams, watching for changes in vision, working closely with both eye doctors and diabetes doctors, and managing blood sugar in a safe, steady way.
Regular Eye Exams Before and During Treatment
The most important step is to have a full eye exam before starting semaglutide. This gives doctors a clear picture of the health of the retina, which is the light-sensitive layer at the back of the eye. Many people with diabetes already have early changes in the retina, called diabetic retinopathy, even if they do not notice any symptoms. Knowing the baseline condition helps doctors see whether things are getting worse after treatment starts.
Once semaglutide treatment begins, regular follow-up exams are key. For many patients, this means seeing an eye doctor once a year. But if someone already has diabetic retinopathy or other eye problems, exams may need to be more frequent, such as every 3 to 6 months. These visits allow the doctor to look for new bleeding, swelling, or changes in the retina that could signal worsening disease. Early detection means treatment can begin right away, which can protect sight.
Monitoring for Visual Symptoms
In between eye exams, patients should pay attention to how their vision feels day to day. Some warning signs include:
- Blurred or hazy vision
- Sudden floaters (dark spots or strings that move across the vision)
- Flashes of light
- Trouble seeing in dim light
- A dark or empty area in the middle of vision
If any of these symptoms appear, it is important to call an eye doctor as soon as possible. These changes can sometimes mean that retinopathy is getting worse. Acting quickly may prevent permanent vision loss. Even small changes in vision should not be ignored.
Coordination Between Endocrinologists and Ophthalmologists
Because semaglutide is usually prescribed by an endocrinologist or a primary care doctor, and eye health is managed by an ophthalmologist, good communication between both specialists is essential. The doctor prescribing semaglutide should know the patient’s eye history, while the eye doctor should know the patient is starting semaglutide.
Sometimes, an eye doctor may suggest extra monitoring or even specific treatments to lower the risk of complications. For example, patients with advanced retinopathy may need more frequent check-ins or laser therapy. A team-based approach ensures that eye health is not overlooked while treating diabetes or obesity.
Importance of Gradual Glucose Control
One of the main reasons semaglutide might affect eye health is that it can lower blood sugar levels very quickly. While this is usually good, a sudden drop in blood sugar can sometimes make existing retinopathy worse. This effect has been seen with other diabetes treatments as well.
To lower the risk, doctors may adjust how fast the dose of semaglutide increases. Instead of pushing for rapid blood sugar control, a slower and steadier approach may give the retina more time to adjust. Patients can also support this by following their doctor’s advice about diet, exercise, and other medications, so their blood sugar changes are more gradual.
Lifestyle Steps That Support Eye Health
In addition to medical care, daily lifestyle choices can help protect vision. These include:
- Keeping blood pressure under control, since high blood pressure adds stress to the eyes.
- Managing cholesterol, which supports overall blood vessel health.
- Not smoking, because smoking damages blood vessels and raises the risk of eye disease.
- Staying active with safe exercise, which helps circulation and blood sugar balance.
These steps may seem simple, but together they create a strong defense against eye complications.
Taking semaglutide can be a powerful way to manage diabetes and obesity, but patients must be proactive about their eye health. The best protection comes from a combination of regular eye exams, paying attention to symptoms, clear communication between doctors, and careful control of blood sugar levels. With the right monitoring and lifestyle habits, patients can lower their risk of eye complications and continue to gain the benefits of semaglutide safely.
How Are Ophthalmologists and Endocrinologists Responding to the Study?
When the JAMA Ophthalmology study came out, it raised an important question: How should doctors who treat diabetes and weight problems react to these possible risks to the eyes? Both ophthalmologists (eye doctors) and endocrinologists (hormone and diabetes specialists) play a key role. They often work together to help patients get the benefits of semaglutide while also protecting their vision.
Ophthalmologists: Focusing on Eye Safety
Ophthalmologists are the doctors who diagnose and treat conditions such as diabetic retinopathy, macular edema, and other problems that affect the retina. They are very aware that sudden changes in blood sugar can sometimes trigger worsening of eye disease. Because of this, the JAMA Ophthalmology findings confirmed what many of them already watch for.
More frequent eye exams
- Many eye doctors now suggest that patients who start semaglutide should get a baseline eye exam if they have not had one recently.
- If a patient already has diabetic retinopathy, follow-up visits may be scheduled more often, sometimes every 3–6 months instead of once a year.
- The goal is to catch any small changes early, before they lead to vision loss.
Better communication with patients
- Ophthalmologists are also explaining the possible risks in simple terms to patients.
- They make it clear that semaglutide itself is not a poison to the eye, but rapid changes in blood sugar may “stress” the delicate blood vessels in the retina.
- By setting the right expectations, patients are more likely to report new symptoms quickly, such as blurry vision, floaters, or sudden vision changes.
Collaboration with endocrinologists
- Eye doctors often send notes or reports to endocrinologists after visits. This communication has become more important.
- If worsening retinopathy is seen, the ophthalmologist may advise slowing down how quickly blood sugar targets are reached.
Endocrinologists: Balancing Benefits and Risks
Endocrinologists are usually the ones prescribing semaglutide. They know the drug can be life-changing for weight loss and blood sugar control. But they must also weigh the possible eye risks, especially for patients with existing diabetic eye disease.
Patient selection
- Endocrinologists are paying closer attention to which patients may face higher risks.
- People with long-standing diabetes, high HbA1c levels, or untreated diabetic retinopathy are now flagged as needing extra eye care.
- Some endocrinologists recommend that patients with moderate to severe retinopathy see an eye doctor before starting semaglutide.
Titration strategies
- Doctors may adjust how quickly the dose of semaglutide is increased.
- A slower increase may help prevent sudden drops in blood sugar, which are thought to trigger eye complications.
- This is not always possible, but it is being discussed more often in clinics.
Coordinated care
- Endocrinologists now regularly tell patients to get eye exams and report vision changes right away.
- Many endocrinologists are building direct communication channels with ophthalmologists so that patients do not “fall through the cracks.”
Shared Approach Between Specialties
The most important response to the study has been teamwork. Semaglutide’s benefits for blood sugar and weight are too valuable to ignore. But so are the risks to vision. Both eye doctors and diabetes specialists are learning that they must work side by side.
Screening protocols
- Joint guidelines are not yet official, but many clinics are creating local protocols.
- These protocols may include:
- mandatory baseline eye exams before starting semaglutide,
- repeat exams within the first year, and
- urgent referrals if vision symptoms occur.
- mandatory baseline eye exams before starting semaglutide,
Patient education
- Doctors from both specialties stress that patients should not stop semaglutide suddenly without medical advice.
- Instead, the focus is on teaching patients what warning signs to look out for, such as new floaters, flashes of light, or sudden dark spots in their vision.
Long-term monitoring
- Because the risks may be highest in the first 1–2 years of treatment, both ophthalmologists and endocrinologists recommend long-term monitoring.
- Even after the “high-risk” period, eye exams remain an important part of diabetes care.
Practical Advice Emerging From the Study
From the combined response of both groups of doctors, several practical steps have emerged:
- No one-size-fits-all answer – Each patient’s risk depends on their eye health, blood sugar levels, and how quickly those levels improve.
- Eye exams are essential – Patients should expect more frequent visits to the eye doctor when starting semaglutide.
- Close follow-up in the first year – This is the time when changes are most likely to occur.
- Shared decision-making – Doctors involve patients in choices about how fast to adjust doses, based on eye health status.
Overall, the response from ophthalmologists and endocrinologists has been careful but not alarmist. They recognize that semaglutide is a very effective drug, but they also recognize that it carries special risks for patients with diabetic eye disease. By working together, these two groups of specialists are helping patients gain the benefits of treatment while lowering the chance of serious eye problems.
Limitations of the JAMA Ophthalmology Study
When looking at the findings of the JAMA Ophthalmology study on semaglutide and eye health, it is important to remember that no single study gives the full picture. While the research was carefully done, it also has limits. Understanding these limits helps doctors, patients, and researchers place the results in the right context. Below, we will go step by step through the main limitations.
The Study Was Not Designed Just for Eye Health
One of the first limits is that the study was not originally built to look only at eye problems. The primary focus of the clinical trials that fed into the analysis was on blood sugar control and overall safety of semaglutide. Eye complications, like diabetic retinopathy worsening, were collected as part of the safety follow-up. Because of this, the study did not use the most detailed or specialized methods that eye-specific research might use, such as high-resolution retinal imaging or long-term vision tests.
This means the study gives us a signal — a clue — that semaglutide may be linked to more eye complications in certain patients, but it does not give all the fine details about how or why.
The Patient Group May Not Represent Everyone
Another important limit is that the group of patients studied may not represent all people who take semaglutide. Many of the patients in the trial already had type 2 diabetes for a long time. Some had poor blood sugar control at the start, and some already had diabetic eye disease.
Because of this, the results may mainly apply to people with long-standing diabetes and not necessarily to people using semaglutide just for weight loss or those with newer diabetes. In other words, the risk seen in the study may not be the same for every patient population.
Limited Follow-Up Time
The follow-up period in the study was not very long. Some of the complications were noticed within the first year of treatment. However, diabetic eye disease often develops and changes slowly over many years. A longer follow-up would be needed to know if the increased risk is only short-term, related to the quick drop in blood sugar, or if it continues over time.
Without long-term follow-up, it is hard to say whether semaglutide causes lasting harm to the eyes or if the risk levels out after the first period of blood sugar improvement.
The Role of Blood Sugar Changes
The study could not fully separate the effects of semaglutide itself from the effects of lowering blood sugar quickly. It has long been known that rapid improvements in blood sugar can make diabetic retinopathy temporarily worse before it gets better. This was seen with insulin decades ago in other clinical trials.
Because semaglutide can lower blood sugar quite quickly, especially in patients who start with high levels, it is possible that the eye complications seen were more about the speed of glucose improvement rather than the drug itself. The study design makes it difficult to prove which factor was most responsible.
Small Number of Events
While the study did find a difference in eye complications, the actual number of events was still relatively small. This means that small changes in patient numbers or reporting could affect the overall risk estimate. Studies with larger patient groups and more eye events would give a clearer and more reliable answer.
Generalizability to Real-World Use
Clinical trials are done in controlled conditions. Patients are closely monitored, and follow-up schedules are strict. In the real world, patients may not have such frequent monitoring or may not get eye exams as often. This can make the risk appear different when semaglutide is used outside of trials.
Also, in real-world practice, many patients are on multiple medications at the same time. This makes it harder to know if the same risk would show up when semaglutide is combined with other treatments.
Need for More Specialized Eye Studies
Because of all these limits, there is a need for more research that looks directly at semaglutide and the eyes. Ideally, new studies should:
- Use detailed eye imaging and vision tests.
- Follow patients for many years.
- Include patients with and without existing diabetic eye disease.
- Compare semaglutide with other diabetes medications under real-world conditions.
These kinds of studies would help confirm if the risks seen in the JAMA Ophthalmology study are temporary, long-term, or only present in certain groups of patients.
The JAMA Ophthalmology study raised an important safety signal about semaglutide and eye health, especially in people with existing diabetic retinopathy. However, the study was not designed as a full eye-focused trial, the follow-up was short, the number of events was small, and it is difficult to separate the effect of the drug from the effect of rapid blood sugar lowering.
For patients and doctors, this means the results should be taken seriously but also viewed as part of a larger body of research that is still growing. More long-term and eye-focused studies are needed before we can fully understand the true relationship between semaglutide and vision changes.
Conclusion
Semaglutide has become one of the most talked about medications in recent years. It is well known for helping people with type 2 diabetes control their blood sugar and for supporting weight loss in people with obesity. Because it works so well in these areas, millions of patients have either already started the medicine or are considering it. But, as with any treatment, there are side effects and risks that need to be understood. The JAMA Ophthalmology study gave us a closer look at one of those possible risks: changes in eye health.
The study suggested that semaglutide may raise the chance of worsening eye problems, especially in people who already have diabetic retinopathy. Diabetic retinopathy happens when high blood sugar damages the small blood vessels in the retina, which is the light-sensitive part of the eye. This can lead to blurry vision, floaters, or even vision loss if it becomes severe. The study did not say that semaglutide causes new eye disease in people without diabetes or retinopathy, but it showed that the drug may speed up problems in those who already have eye disease.
Why might this happen? One possible reason is how quickly semaglutide can lower blood sugar. When blood sugar levels drop fast, the tiny vessels in the retina may not have time to adjust. This sudden shift may stress the eye, especially if damage is already present. Another idea is that changes in body weight and blood pressure that happen with semaglutide might also influence the eye’s circulation. While these are helpful changes overall, they can have short-term effects that put stress on sensitive tissues in the eye. Scientists are still studying these details, but the link is important enough for doctors to take it seriously.
It is important to remember that not everyone who takes semaglutide will have eye problems. In fact, most people who use the drug do not experience severe vision changes. The risk appears highest in people with a long history of diabetes, poor blood sugar control before starting treatment, or existing retinopathy. For these patients, the sudden improvement in glucose levels may be too much for the eye to handle all at once. That does not mean these patients cannot take semaglutide, but it does mean they should be followed more closely.
The JAMA Ophthalmology study adds to our knowledge, but it also has limits. It was not designed to give all the answers. It tells us that there is an association between semaglutide and eye complications, but it cannot fully prove that semaglutide is the cause. Other factors, like how sick the patients were at the start of the study, may play a role. More research is needed, especially long-term studies that track different groups of patients over time. Only then will we know for sure how much risk is tied directly to the medication and how much is related to other health conditions.
What does this mean for patients today? It means that eye health should be part of the conversation before and during treatment with semaglutide. Doctors already recommend that people with diabetes get regular eye exams, but this becomes even more important if semaglutide is started. An exam at baseline, before the medication begins, can give doctors a clear picture of eye health. After that, scheduled checkups can catch any early changes. If problems do appear, treatment can be adjusted quickly.
Patients also need to know the warning signs. Blurry vision, sudden floaters, flashes of light, or dark spots in vision should never be ignored. These changes should lead to an urgent appointment with an eye doctor. The sooner eye complications are found, the better the chance of protecting sight.
At the same time, the benefits of semaglutide should not be overlooked. Better blood sugar control lowers the long-term risk of kidney disease, nerve problems, heart attacks, and strokes. Weight loss also improves blood pressure, cholesterol, and overall health. For many patients, these benefits outweigh the possible risks. The key is balance: using semaglutide in a safe way while carefully watching for side effects.
Doctors, endocrinologists, and ophthalmologists are now working together more closely because of this research. They are updating how they monitor patients and how they talk about risks. For patients, this means more teamwork in their care. Medicine is rarely about perfect answers—it is about weighing benefits against risks and making the best choice for each person.
In summary, the JAMA Ophthalmology study highlights something that patients and doctors need to keep in mind: semaglutide may speed up certain eye problems, especially in people with existing diabetic retinopathy. But the drug also brings powerful health benefits. The safest path is not to avoid treatment out of fear, but to use it wisely with good monitoring. By combining effective medications with regular eye care, patients can gain the benefits of semaglutide while reducing the risks to their vision. This balance is the goal of modern medicine: helping people live longer, healthier lives without losing sight—literally—of the complications that can come along the way.
Research Citations
Hathaway, J. T., Shah, M. P., Hathaway, D. B., et al. (2024). Risk of nonarteritic anterior ischemic optic neuropathy in patients prescribed semaglutide. JAMA Ophthalmology, 142(8), 732–739.
Cai, C. X., Hribar, M., Baxter, S., et al. (2025). Semaglutide and nonarteritic anterior ischemic optic neuropathy. JAMA Ophthalmology, 143(4), 304–314.
Natividade, G. R., Spiazzi, B. F., Baumgarten, M. W., et al. (2025). Ocular adverse events with semaglutide: A systematic review and meta-analysis. JAMA Ophthalmology, 143(9), 759–768.
Katz, B. J., Lee, M. S., Lincoff, N. S., et al. (2025). Ophthalmic complications associated with the antidiabetic drugs semaglutide and tirzepatide. JAMA Ophthalmology, 143(3), 215–220.
Etminan, M., Sodhi, M., & Maberley, D. (2025). GLP-1 RAs and nonarteritic anterior ischemic optic neuropathy—Making sense of the data. JAMA Ophthalmology, 143(3), 220–221.
Rizzo, J. F., III, & Hathaway, J. T. (2025). Semaglutide and risk of NAION—Additional insights. JAMA Ophthalmology, 143(4), 315–316.
Klonoff, D. C., & Gombar, S. (2025). Association of semaglutide and NAION reviewed. JAMA Ophthalmology, 143(8), 716.
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Wang, L., Volkow, N. D., Kaelber, D. C., & Xu, R. (2025). Semaglutide or tirzepatide and optic nerve and visual pathway disorders in type 2 diabetes. JAMA Network Open, 8(8), e2526327.
Questions and Answers: Semaglutide Jama Ophthalmology Study
The study asked whether prescriptions for semaglutide are associated with an increased risk of nonarteritic anterior ischemic optic neuropathy in patients with type 2 diabetes or in those who are overweight or obese.
It was a retrospective matched cohort study, using propensity matching to compare patients prescribed semaglutide versus non–GLP-1 RA medications, adjusting for confounders.
The cohort included 16,827 patients with no prior history of NAION.
Among the diabetic cohort, the hazard ratio for NAION in semaglutide users versus non-GLP-1 RA users was 4.28 with a 95 percent confidence interval of 1.62 to 11.29.
In that subgroup, semaglutide use was associated with a hazard ratio of 7.64 with a 95 percent confidence interval of 2.21 to 26.36 compared to non–GLP-1 RA medications.
The multicenter study found a smaller increase in relative incidence of NAION with semaglutide exposure compared to nonexposure than earlier reports, offering further evidence of an association but acknowledging that the magnitude of risk is more modest.
No. In randomized clinical trials, semaglutide was not associated with a higher risk of general eye disorders or diabetic retinopathy. However, an association with NAION remained.
In a small case series of nine patients, the reported complications included seven patients with NAION, one with papillitis, and one with paracentral acute middle maculopathy.
One hypothesis is that rapid correction of hyperglycemia induced by semaglutide, meaning rapid glucose lowering, may precipitate optic nerve ischemic events rather than a direct toxic effect of the drug.
Some important caveats are: observational design with risk of residual confounding and inability to prove causality, relatively small number of NAION events reducing precision, incomplete capture of ophthalmology diagnoses or follow-up in large databases, heterogeneity in definitions of NAION and comparator groups, and potential surveillance bias because patients on semaglutide may be monitored more closely.
