At a glance: AOA-flagged ocular risks NAION (Non-Arteritic Anterior Ischemic Optic Neuropathy) Identified as a very rare but serious risk associated with semaglutide, the most prescribed GLP-1RA (Ozempic, Wegovy, Rybelsus) Up to 2 increased risk with semaglutide use After conducting risk assessment, the European Medicines Agency (EMA) calls for updated product info to list NAION as a very rare side effect Signs: Sudden, painless unilateral vision loss, visual field defect, dyschromatopsia, and optic disc swelling Discontinue GLP1RA and refer immediately if NAION is suspected Diabetic retinopathy (DR) progression In the SUSTAIN-6 trial, semaglutide users showed a higher rate of DR complications (3.0%) than placebo (1.8%) This may result from rapid HbA1c reduction, a known contributor to early DR worsening Especially concerning in patients with preexisting DR Perform a baseline dilated eye exam and follow up within 1218 months of treatment initiation Neovascular AMD A population-based study found GLP-1RA users had a 2 higher relative risk of developing wet AMD (0.2% vs 0.1%) Though absolute risk remains low, the potential impact is vision-threatening Closely monitor individuals with AMD risk factors or history Other rare events Isolated reports of: Uveitis Diplopia Optic neuropathies beyond NAION These are not yet confirmed by large-scale trials but suggest the need for comprehensive baseline evaluations
Ge H, et al
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