Ophthalmic Complications Associated With Semaglutide and Tirzepatide

Interview with Bradley J. Katz, MD, PhD, author of Ophthalmic Complications Associated With the Antidiabetic Drugs Semaglutide and Tirzepatide. Hosted by Neil Bressler, MD.
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Ophthalmic Complications Associated With the Antidiabetic Drugs Semaglutide and Tirzepatide
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Podcast was originally published on January 30, 2025.
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Semaglutide and tirzepatide are both GLP-1 receptor agonists that have shown effectiveness in managing type 2 diabetes and obesity. However, there have been reports of certain ophthalmic complications associated with these drugs, though they are considered rare.
Potential ophthalmic complications include:
Diabetic Retinopathy (DR) Progression: One of the most noted concerns with GLP-1 receptor agonists, including semaglutide and tirzepatide, is their potential to accelerate diabetic retinopathy (DR) progression in patients with pre-existing DR. Studies have shown that rapid reductions in blood glucose levels, which occur with these medications, might exacerbate the progression of retinopathy in patients with diabetes. This can lead to more severe vision problems or even blindness if not managed appropriately.
Macular Edema: Another complication linked to these medications is macular edema, where fluid accumulates in the macula of the retina, potentially impairing vision. This is often seen in patients who already have diabetic retinopathy or are at risk for it. The exact mechanism behind this connection is still under investigation, but some theories suggest that rapid changes in blood sugar levels may impact the retinal vasculature, contributing to swelling.
Blurred Vision: Patients starting on semaglutide or tirzepatide may experience blurred vision, particularly during the initial phase of treatment. This could be related to fluctuations in blood glucose levels as the body adjusts to the new medication. It’s important for individuals experiencing this symptom to discuss it with their healthcare provider, as persistent or severe vision changes may warrant further investigation.
Retinal Vascular Events: There have been isolated reports of retinal vascular events like retinal vein occlusion, though these events are not common and their exact relationship with GLP-1 receptor agonists remains unclear. Some clinicians caution monitoring for these rare events, especially in individuals with pre-existing vascular conditions or those at high risk for vascular diseases.
Managing ophthalmic risks includes regular eye exams for individuals starting on semaglutide or tirzepatide, especially for those with diabetes or a history of diabetic retinopathy. For patients with diabetic retinopathy, healthcare providers may need to adjust the medication regimen to ensure that rapid improvements in blood glucose do not exacerbate the retinopathy. Close monitoring of visual symptoms, such as blurred vision or visual disturbances, is critical to identify any potential ophthalmic complications early.
As with any medication, the benefits of semaglutide and tirzepatide in managing blood sugar levels and aiding in weight loss often outweigh the potential risks. However, understanding and addressing ophthalmic complications are vital for ensuring the overall safety of patients, particularly those with underlying eye conditions like diabetic retinopathy. Always consult with healthcare professionals to tailor treatment plans and monitor any side effects appropriately.