Should You Be Worried About Ozempic and Eye Disease?

Can you go blind from taking Ozempic? Recent studies on the increased risk of a certain kind of eye condition associated with semaglutide (the active ingredient in Ozempic and Wegovy) have understandably got a lot of people asking this question.

Of course this isn't the first or only side effect we’ve heard about with GLP-1 receptor agonists. And I know it can be hard to determine what’s a real risk, what might be overblown, and what you might be missing.

So today, I’m going to break down what the research shows about Ozempic and eye disease, as well as what the research doesn’t tell us, and how my team and I are thinking about semaglutide overall in our functional medicine telehealth practice.

What Is the “Ozempic Eye Condition” (NAION)?

The eye condition that’s been associated with Ozempic and semaglutide in general is called non-arteritic anterior ischemic optic neuropathy, or NAION for short.

It’s characterized by a lack of blood flow to the optic nerve (which carries signals from the eye to the brain), and usually affects just one eye. NAION can cause a sudden loss of vision. In most cases of NAION vision loss is painless, and is noticed upon waking.

NAION isn’t a new condition, but it’s been getting more widespread attention because of its newly identified potential link to injectable weight loss drugs like Ozempic.

We’ll get to that connection in a minute, but first, here are some of the other known risk factors for developing NAION: (1)

• High blood pressure (hypertension)
• Cardiovascular disease
• Diabetes
• Sleep apnea
• The use of certain medications
• Smoking

Semaglutide and Risk of Eye Disease: What the Research Says

There are two prominent new studies that have come out on semaglutide and NAION. Both are retrospective cohort studies, a type of observational research that involves looking back at existing or historical patient data to analyze the relationship between an exposure and an outcome.

These studies were set up similarly, so I’ll focus on one for now: the paper titled Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide, which was published in JAMA Ophthalmology. (2)

Researchers analyzed records of more than 16,000 patients who:

• Had seen a neuro-ophthalmologist at a particular institution between 2017 and 2023, and;
• Had no previous history of NAION

From there, they identified patients who had type 2 diabetes, and patients who were overweight and/or had obesity. These two groups were split further into those who were prescribed semaglutide and those who were prescribed different (non-semaglutide) medications to manage their diabetes or overweight/obesity.

Then, the researchers looked at how many people in each group developed NAION, to see what the association was with semaglutide.

Here’s what they found:

• In the diabetes group:
• 17 out of 194 patients taking semaglutide developed NAION (8.9%)
• 6 out of 516 patients taking non-semaglutide drugs developed NAION (1.8%)
• In the overweight or obese group:
• 20 out of 361 patients taking semaglutide developed NAION (6.7%)
• 3 out of 618 patients taking non-semaglutide drugs developed NAION (0.8%)

We can see from these numbers that more people who were taking semaglutide developed this eye condition, compared with those who were taking different medications. The researchers concluded that there was an association between semaglutide and NAION (with an observational study, we can only identify association, not causation).

A Danish-Norwegian cohort study that looked at a larger population of type 2 diabetes patients only, and compared semaglutide to a more specific kind of diabetes medication (sodium-glucose co-transporter 2 inhibitors, or SGLT-2is), also identified a greater relative risk of NAION among semaglutide users– although the absolute risk was a lot lower than what we saw in the JAMA study. (3)

Study Limitations

There are a few limitations to these studies (beyond the fact that by nature an observational study can’t prove causation):

• The JAMA study only looked at patients from one center. This may be a skewed population, and it would be helpful to see more multi-center studies looking at a broader population.
• The patient populations studied here are already an at-risk group for NAION (people with diabetes and/or metabolic problems). It would be helpful to look at any effects on healthy individuals taking semaglutide. (Also, patients who are prescribed semaglutide have often not responded to other obesity or diabetes drugs. This may be due to increased metabolic dysfunction that would already make them more at risk of developing NAION.)
• The number of events (incidences of NAION) across both studies is quite low (this is still a rare eye condition).

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Is It the Drug Or the Dose?

The higher risk of NAION identified in these studies, even without being able to prove causation, is absolutely worth paying attention to, and understandably scary for those who are taking or considering taking semaglutide.

But there are also other factors to consider. One of the most important ones is that researchers have hypothesized the rapid drop in blood sugar levels is what may contribute to the increased risk of NAION in patients taking semaglutide and the similar medication tirzepatide (Mounjaro, Zepbound). (4)

We’ve all heard the stories about GLP-1 drugs like Ozempic and rapid, dramatic weight loss– and rapid correction of blood sugar levels goes along with this. But these fast and dramatic changes are connected to the way semaglutide is often being used as much as to the medication itself.

To take a step back, semaglutide is a peptide that mimics the action of glucagon-like peptide-1 (GLP-1), a blood sugar and appetite regulating hormone we produce naturally.

While mainstream medicine and popular diet culture have latched on to the more dramatic effects of macro doses (which also come with many risks of side effects), there is still a case to be made for a more conservative and subtle use of this peptide (i.e. microdosing) alongside lifestyle changes to kickstart metabolic change.

And without the massive, rapid changes to blood sugar, it would stand to reason that the risk of NAION would be decreased. Studies haven’t looked at this yet to my knowledge, but hopefully future research will address this question.

Other Side Effects of Semaglutide

Beyond eye health concerns, there are other risks and potential side effects to be aware of, especially if taking macro doses of semaglutide.

These may include:

• Digestive issues (5)
• Muscle loss
• Increased risk of thyroid tumors
• Pancreatitis (inflammation of the pancreas) (6)

These risks are again why I would generally recommend only low and slow doses of semaglutide, while looking into the root cause of any metabolic dysfunction (root causes often include inflammatory diets, toxin exposure, chronic stress, and/or gut imbalances).

Also– did you know there are certain foods and supplements (shoutout to berberine, “nature’s Ozempic”) that can naturally boost GLP-1 levels? Check those out.

Of course, always make sure to speak with your healthcare provider before making any changes.

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Final Thoughts On Ozempic and Eye Disease

Overall, my takeaway when it comes to Ozempic and eye problems is that there is clearly a risk– and that we also need to pay attention to how a treatment is being used, not just what it is.

Research will continue to uncover more about the effects of semaglutide on the body, and hopefully, we will start to see some studies that look at more conservative, short-term dosing.

Ultimately, we need to do more to support metabolic health through diet, lifestyle, and preventative, holistic, root-cause focused strategies. If you’re looking for support for your own metabolic health, please reach out to my functional medicine clinic– we consult with patients virtually and have years of experience restoring metabolic function.

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.