Can semaglutide (Ozempic, Wegovy) and other GLP-1 receptor agonists cause vision loss?

Recent studies published in JAMA Ophthalmology have identified a potential association between semaglutide (Ozempic, Wegovy) and nonarteritic anterior ischemic optic neuropathy (NAION), a rare eye condition that can cause sudden vision loss. However, the absolute risk remains low, and patients should not stop taking semaglutide without consulting their healthcare provider.

Study Findings on Semaglutide Vision Loss Risk

A 2024 retrospective, matched cohort study of 16,827 neuro-ophthalmic patients at Massachusetts Eye and Ear in Boston found patients taking semaglutide had significantly higher rates of NAION compared to those taking other medications. Among diabetes patients, about 9% of semaglutide users developed NAION over three years versus only 2% of those taking other diabetes drugs, meaning semaglutide users were over 4 times more likely to experience this condition. For those using semaglutide for weight loss, nearly 7% developed NAION compared to less than 1% of those taking other weight-loss medications, making semaglutide users over 7 times more likely to develop the eye condition. While these risk increases are substantial, it's important to note that NAION remained uncommon overall.

A much larger February 2025 retrospective study of 37 million diabetes patients across 14 databases found that about 14-15 cases of vision problems (NAION) per 100,000 patients yearly were reported in semaglutide users. Compared to other diabetes drugs, semaglutide showed no significant difference in risk for most comparisons, though one analysis found a 32% increased risk when patients were compared to themselves before starting the medication. The absolute risk remained very low overall.

Implications for Other GLP-1 Receptor Agonists

The vision loss risk may extend beyond semaglutide to other GLP-1 receptor agonist medications. The February 2025 study found that semaglutide users did not have significantly higher NAION risk compared to patients taking other GLP-1 RA drugs, suggesting this may be a class-wide effect rather than specific to semaglutide alone. This means other GLP-1 medications like liraglutide (Victoza, Saxenda), dulaglutide (Trulicity), exenatide (Byetta, Bydureon), and tirzepatide (Mounjaro, Zepbound) may carry similar vision loss risks.

However, research specifically examining NAION rates with these other GLP-1 receptor agonists is limited. The mechanism behind the potential GLP-1 RA and NAION association remains unknown, making it unclear whether the risk varies between different medications in this drug class. Patients taking any GLP-1 receptor agonist should be aware of this potential risk and discuss vision changes with their healthcare providers, though the absolute risk remains low across all these medications.

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What is NAION?

NAION typically causes sudden vision loss in one eye due to reduced blood flow to the optic nerve, damaging neurons that transmit visual information to the brain. While serious, NAION remains a rare condition.

Medical Expert Recommendations

Researchers emphasize that GLP-1 receptor agonists provide substantial benefits, including improved diabetes management, significant weight loss, reduced cardiovascular events, and decreased mortality. Expert advice currently recommends that patients should not stop semaglutide based solely on NAION risk, given the medication's proven therapeutic benefits and the condition's low absolute risk.
However, added caution is recommended for patients with previous vision loss from any cause who are considering semaglutide treatment.

Bottom Line

While studies suggest an association between semaglutide and NAION, the absolute risk remains very low. The mechanism behind this potential connection is not yet understood, and more research is needed to establish causality. Patients should discuss these findings with their healthcare providers to weigh individual risks and benefits.

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