Ozempic and Your Eyes: Why an Ophthalmologist’s Examination is the First Step to Therapy

  • Article about the connection between Ozempic and occurring eye problems and eye diseases (Photo Copyright: Kassandra, Adobe Stock)

Are you planning a therapy with Semaglutide (trade name Ozempic® or Wegovy®) to better manage your diabetes or achieve weight reduction? This is often a medically very sensible decision for your general health.

However, before your first injection of Ozempic® or Wegovy®, a specialized ophthalmological examination is essential. The eye is a highly sensitive organ that can sometimes react unexpectedly to the strong metabolic interventions of this medication, and your vision can be damaged as a result.

We would like to explain why you should have a thorough eye examination before starting therapy and what risks you can rule out by doing so.

1. Worsening of Diabetic Retinopathy, or: The Retinal Paradox (“Early Worsening”)

It sounds contradictory: in the long term, good blood sugar levels protect your eyes. In the short term, however, a too rapid reduction in blood sugar (HbA1c value), as is often achieved with Ozempic®, can be dangerous.

The delicate blood vessels of your retina have become “accustomed” to high sugar levels over years. If sugar is withdrawn too abruptly, the vessel walls come under stress. This can lead to a temporary worsening of diabetic retinopathy – resulting in hemorrhages or fluid accumulation (edema) in the center of the retina.

Our goal: We must check in advance whether your retina is stable enough for a rapid blood sugar reduction, or whether your internist/diabetologist needs to increase the dose more slowly.

2. The Risk to the Optic Nerve (NAION)

Recent data suggest an increased risk of so-called “optic nerve infarction” (medical term: NAION – Non-arteritic Anterior Ischemic Optic Neuropathy) during Semaglutide therapy. This leads to sudden, often permanent vision loss. Fortunately, this severe complication is very rare, occurring in about 1 in 10,000 patients. Studies show a 2- to 7-fold increased risk of NAION during Semaglutide therapy:
Patients who received Semaglutide for the treatment of their diabetes had an approximately 2-fold increased risk.
However, patients treated for weight reduction had an almost 7-fold increased risk.

And: It primarily affected people with a specific anatomical peculiarity of the optic nerve head, a so-called “Crowded Disc.”

A “Crowded Disc” refers to a congenital anatomical configuration of the optic nerve head (papilla) where the opening in the eyeball through which the optic nerve exits the eye is very narrow relative to the thickness of the optic nerve.
In ophthalmology, it is often referred to as a “Disc at Risk,” as this significantly increases the risk of NAION.
The normally recognizable depression in the center of the optic nerve head (the papilla) is almost completely absent, and the margins of the optic nerve can sometimes appear slightly blurred or elevated, even without pathological swelling (pseudopapilledema).

Our goal: We measure the entry angle and the space conditions of your optic nerve (cup-to-disc ratio). This involves a clinical examination, photo documentation, and objective high-resolution measurement of the papilla using OCT (Optical Coherence Tomography). If a critical anatomical narrowness exists here (ratio < 0.2), the risk of occlusion under Ozempic® is significantly increased. In this case, the medication must be viewed critically from an ophthalmological perspective.

3. Fluctuations in Visual Acuity

In the first weeks of Semaglutide therapy, many patients notice blurred vision or that their glasses no longer seem to fit.

This is due to osmotic changes in the eye lens: the decreasing sugar content changes the water balance of the lens and thus its refractive power.

The good news: This is usually harmless and reversible. However, it is important to distinguish this symptom from the serious complications mentioned above. Do not buy new glasses during this phase; wait until the values have stabilized.

Conclusion: Safety Before Speed

Ozempic® therapy is a powerful tool. For this tool to benefit your body and not harm your eyes, we need the status quo before starting therapy.

Our examination serves as your safety barrier:

  1. Exclusion of anatomical risk factors for the optic nerve (Crowded Disc).
  2. Documentation of the retinal condition before rapid metabolic changes (blood sugar reduction / weight loss).
  3. Determination of individual control intervals.

Please schedule your appointment for the “Semaglutide preliminary examination” well in advance of the planned therapy start. Your eyesight is a priority.

 

Header image photo: © Kassandra, Adobe Stock