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Taking Ozempic?

Ozempic (semaglutide) is a medication used to help manage type 2 diabetes. It belongs to a class of drugs called GLP-1 receptor agonists, which help lower blood sugar by increasing insulin release, decreasing glucagon secretion, and slowing gastric emptying.1,2 It has revolutionized diabetes management, but its ocular effects require careful consideration – especially for patients with diabetic retinopathy or those planning on elective surgery requiring sedation, such as cataract surgery. This guide combines the latest research with practical recommendations for safeguarding vision.

Ozempic and Diabetic Eye Complications: Key Concerns

Diabetic Retinopathy Progression

Rapid glycemic control with sudden drop in A1c with semaglutide may temporarily worsen diabetic retinopathy due to changes in retinal blood flow.3,4

Temporary Blurred Vision

Semaglutide can lead to temporary blurred vision due to rapid changes in blood sugar levels.5 It is understood that the pathophysiology is similar to when there is rapid blood sugar fluctuation that changes the thickness of the lens, resulting in refractive error shift and blurred vision.

Non-arteritic Anterior Ischemic Optic Neuropathy (NAION)

Some research suggests a potential link between semaglutide and NAION, a rare but serious condition that causes sudden painless vision loss due to reduced blood flow to the optic nerve.6 Comorbid NAION risk factors include vascular diseases (ie. Diabetes, hypertension, hypercholesterolemia), cardiovascular disease, sleep apnea, history of smoking, and specific optic nerve anatomy.

The FOCUS Trial: Shedding Light on Ocular Effects

The FOCUS clinical trial is investigating the long-term ophthalmic effects of semaglutide in patients with type 2 diabetes. This controlled study aims to understand how semaglutide impacts the progression of diabetic retinopathy by incorporating standardized ophthalmic assessments.7 The trial’s results, expected in 2027, are expected to provide valuable insights for eye care professionals (ophthalmologists and optometrists) and endocrinologists managing diabetic patients.

Cataract Surgery Considerations

Diabetic patients, especially those that already have significant diabetic retinopathy, face higher risks of postoperative macular edema or retinopathy progression after cataract surgery. Proper assessment pre-operatively by your eye care team to determine risks and management plan as well as post-operative close monitoring is critical for a successful recovery and maintaining optimal vision.

The American Society of Anesthesiologists (ASA) recently released guidelines on the perioperative management of GLP-1 agonists, including Ozempic.8 These guidelines recommend that most patients can continue using GLP-1 agonists before elective surgeries like cataract surgery. However, patients at higher risk for gastrointestinal side effects may follow a liquid diet 24 hours prior to surgery to minimize aspiration risks.

For Surgery at our North Toronto Eye Surgical Centre, please let our surgical team be aware of your full list of medications including Ozempic. Your team of surgeon, anesthesiologist and nurses will create an individualized plan prior to surgery for optimal glycemic control and maximize your safety.

For More Information on Patient Instructions for Cataract Surgery

Patient Recommendations for Ocular Safety

Pre-Ozempic Eye Care

For diabetic patients considering Ozempic, baseline eye examinations are crucial to assess existing ocular conditions. Those with a history of diabetic retinopathy should schedule follow-up appointments sooner after starting Ozempic to monitor for any changes.

For More Information on Diabetic Retinopathy

Collaboration within your Circle of Care

Collaboration and communication between your primary care physician, ophthalmologist, and endocrinologist is essential to ensure comprehensive care.

Symptom Vigilance

Monitor for blurred vision (often temporary, resolving within a few months) and report sudden vision loss immediately to your eye care professional (ophthalmologist or optometrist).

Key Takeaways for North Toronto Eye Care Patients

  • Early Monitoring and Detection: Diabetic Eye Examinations are crucial in managing diabetic retinopathy and early intervention for improved vision outcomes.
  • Stay Informed: The FOCUS trial’s 2027 results will guide future semaglutide use in high-risk groups
  • Team Approach: Coordinate with your endocrinologist, ophthalmologist, and optometrist for seamless care.

By balancing Ozempic’s benefits in type 2 diabetes management with proactive eye care, patients can protect their vision while managing their diabetes effectively. Schedule a comprehensive diabetic eye exam at North Toronto Eye Care to create your personalized plan.

References

  1. Drug Trial Snapshot: Ozempic. US Food & Drug Administration. Published August 20, 2020. https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trial-snapshot-ozempic.
  2. NovoMedlink Semaglutide. Novo Nordisk. Published 2024. https://www.novomedlink.com/semaglutide/medicines.html?gclid=3d6d6df41d2f1c2e83200bce909846c4&gclsrc=3p.ds&&utm_source=bing&utm_medium=cpc&utm_term=semaglutide%20use&utm_campaign=1_All_Shared_BR_Semaglutide_General&utm_content=-dc_pcrid_73942464265740_pkw_semaglutide%20use_pmt_bp_slid__product_&pgrid=1183076224196362&ptaid=kwd-73942517735090:loc-190&msclkid=3d6d6df41d2f1c2e83200bce909846c4.
  3. Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834-1844.
  4. Sharma A, Parachuri N, Kumar N, et al. Semaglutide and the risk of diabetic retinopathy-current perspective. Eye (Lond). Published online August 9, 2021. doi: 10.1038/s41433-021-01741-5
  5. Xiao G. Food and Drug Administration Adverse Event Reports of Diabetic Retinopathy, Macular Edema and Blurred Vision Associated with GLP-1 Receptor Agonist Use. ARVO Annual Meeting Abstract. June 2020. https://iovs.arvojournals.org/article.aspx?articleid=2766443.
  6. Hathaway JT, Shah MP, Hathaway DB, et al. Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide. JAMA Ophthalmol. Published online July 3, 2024. doi:10.1001/jamaophthalmol.2024.2296
  7. Novo Nordisk A/S. A research study to look at how semaglutide compared to placebo affects diabetic eye disease in people with type 2 diabetes (FOCUS). ClinicalTrials.gov. clinicaltrials.gov/study/NCT03811561.
  8. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. June 29, 2023. American Society of Anesthesiologists (ASA). https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative.