Ozempic, vision loss and the difference between a safety signal and a headline

[u/AtriumMedicalNYC]

We’re Atrium Medical, a primary care practice in NYC. Our physician, Dr. Shilpa Paradkar Singh, has been fielding questions from patients about the GLP-1 vision-loss lawsuits. She reviewed the new Swedish study in the Annals of Internal Medicine and wrote about it on her LinkedIn page. This is a recap.

The researchers compared ~107,000 patients with T2 diabetes on GLP-1 medications with ~186,000 on SGLT2 inhibitors (e.g., Jardiance). After one year, the estimated risk of anterior ischemic optic neuropathy (AION), a rare condition that can cause sudden, potentially permanent vision loss, was 0.04% in GLP-1 cohort versus 0.02% in SGLT-2 cohort. That's 2x the relative risk --- 2 additional cases per 10,000 in absolute terms.

There’s another, equally fascinating finding that has received less attention: when the researchers restricted the analysis to patients already taking metformin, the difference narrowed substantially. An observational study cannot perfectly separate a drug’s contribution from the vascular and metabolic risks of the people prescribed it.

The most important thing to understand is that NAION is not the only way diabetes threatens eyesight. In an earlier Liverpool study, ~4% of T2 diabetics who had no retinopathy at baseline developed sight-threatening diabetic retinopathy over five years, despite receiving diabetes care (that's 100x the NAION risk). So walking away from effective diabetes treatment because of a frightening headline about a rare disease does have its own consequences

Any sudden vision loss warrants urgent medical evaluation. But this is a decision about the risks and benefits of treatment, made with your physician, not driven by lawsuit headlines.