Use of Semaglutide and tirzepatide use linked to ophthalmic complications, finds study

Almost 2% of the U.S. population received prescriptions for the weight-loss and diabetes drugs semaglutide and tirzepatide in 2023. These medications, best known by brand names like Ozempic and Mounjaro, have gained popularity for their effectiveness in managing Type 2 diabetes and obesity. However, this recent study published in the Journal of American Medical Association raised concerns about potential ophthalmic complications associated with these drugs.

This retrospective case series was conducted in a community setting, where 9 patients (average age 57.4 years, ranging from 37 to 77 years) were identified as having experienced significant eye health issues while taking either semaglutide or tirzepatide. Among them, 5 were women, and 4 were men.

The most frequently reported complication was nonarteritic ischemic anterior optic neuropathy (NAION) that can lead to sudden and sometimes permanent vision loss, affecting 7 of the 9 patients. One patient presented with bilateral papillitis, a rare inflammation of the optic nerve, while another suffered from paracentral acute middle maculopathy, which is marked by impaired blood flow to the retina, potentially affecting central vision.

What made these cases particularly atypical were features such as sequential ischemic optic neuropathy (occurring in both eyes at different times), persistent bilateral disc swelling, and progressive vision loss even after initial presentation. This study stressed that their findings do not conclusively establish a causal link between the medications and the reported vision problems.

However, one hypothesis suggests that the rapid correction of blood sugar levels caused by these medications, rather than a toxic drug effect, may trigger these complications. Sudden improvements in glucose levels could potentially affect blood flow to the optic nerve or other structures in the eye, leading to the complications observed. While these cases remain relatively rare given the vast number of prescriptions filled, the outcomes emphasize the importance of further investigation.

Ophthalmologists and physicians are encouraged to monitor patients taking semaglutide or tirzepatide for any signs of vision changes. The patients experiencing sudden vision loss, blurred vision, or other visual disturbances while on these medications should seek immediate medical attention. Early detection and intervention could be critical in preventing permanent damage. As research continues, clinicians will likely weigh these potential risks against the well-documented benefits of semaglutide and tirzepatide in managing diabetes and obesity.

Source:

Katz, B. J., Lee, M. S., Lincoff, N. S., Abel, A. S., Chowdhary, S., Ellis, B. D., Najafi, A., Nguyen, J., Seay, M. D., & Warner, J. E. A. (2025). Ophthalmic complications associated with the antidiabetic drugs semaglutide and tirzepatide. JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2024.6058