Semaglutide Linked to Sudden Vision Change NAION

Semaglutide Linked to Sudden Vision Change NAION

(HealthDay News) — Semaglutide is associated with nonarteritic anterior ischemic optic neuropathy (NAION) among patients with type 2 diabetes (T2D) and those with overweight/obesity, according to a study published online July 3 in JAMA Ophthalmology.

Jimena Tatiana Hathaway, M.D., M.P.H., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues examined the potential association between semaglutide and the risk for NAION in a retrospective matched cohort study. Data were obtained for 16,827 patients, including 710 with T2D (194 prescribed semaglutide; 516 prescribed non-glucagon like peptide 1 receptor agonist [GLP1-RA] antidiabetic medications) and 979 with overweight or obesity (361 prescribed semaglutide; 618 prescribed non-GLP1 RA weight-loss medications).

The researchers observed 17 and six NAION events in patients prescribed semaglutide and non-GLP1 RA medications, respectively. Over 36 months, the cumulative incidence of NAION among patients with T2D was 8.9 and 1.8 percent for the semaglutide and non-GLP1 RA cohorts, respectively. The risk for NAION was significantly higher for patients receiving semaglutide (hazard ratio, 4.28) in a Cox proportional hazards regression model. Among patients with overweight or obesity, there were 20 and three NAION events in the semaglutide and non-GLP1 RA cohorts, respectively. The cumulative incidence of NAION over 36 months was 6.7 and 0.8 percent for semaglutide and non-GLP1 RA medications, respectively, with a higher risk for NAION seen for patients prescribed semaglutide (hazard ratio, 7.64).

“There has been no prior mention, to our knowledge, of an increased risk of NAION in association with semaglutide, and our study does not inform a mechanism to link semaglutide to NAION,” the authors write.

What is semaglutide?

As previously reported by BDOPro, semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 is a natural hormone produced in the gut that regulates blood sugar levels. Semaglutide mimics the effects of GLP-1, making it primarily used for treating type 2 diabetes. It’s available as both an injectable and a daily oral medication.

What is NAION?

Nonarteritic anterior ischemic optic neuropathy (NAION) is a condition that disrupts vision due to a lack of blood flow in the optic nerve. The optic nerve, acting as a cable, transmits visual information from the eye to the brain. When blood flow to the front portion of this nerve (anterior) is compromised due to non-inflammatory reasons (nonarteritic), vision loss can occur suddenly and often painlessly.

NAION is the leading cause of optic nerve swelling (edema) in adults over 50. The exact cause of the blood flow disruption remains under investigation, but several risk factors are strongly associated with the condition. These include high blood pressure (hypertension), high cholesterol (hyperlipidemia), diabetes, and sleep apnea. Anatomic variations in the optic nerve itself, where the nerve fibers are crowded, may also contribute to NAION by making it more susceptible to insufficient blood supply.

The hallmark symptom of NAION is sudden, painless vision loss in one eye, typically noticed upon waking. The vision loss can vary in severity, ranging from blurred vision to a complete loss of central vision. Visual field defects, particularly affecting the upper or lower halves of the field, are also common.

Diagnosis of NAION is primarily based on a comprehensive eye examination by an ophthalmologist. This examination includes assessing visual acuity, visual field testing, and examining the optic nerve for signs of swelling and potential hemorrhages. In some cases, additional tests may be needed to rule out other causes of vision loss, such as giant cell arteritis (a different type of optic nerve inflammation).

Unfortunately, there is no cure for NAION. Treatment focuses on managing underlying risk factors like high blood pressure and diabetes to prevent further vision loss. In some cases, medications to improve blood flow or reduce optic nerve swelling may be prescribed, although their effectiveness remains under debate. While vision loss associated with NAION often stabilizes, some degree of permanent vision impairment is likely. Early diagnosis and management of risk factors are crucial to minimize vision loss and improve overall outcomes.

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