Welcome to r/science! This is a heavily moderated subreddit in order to keep the discussion on science. However, we recognize that many people want to discuss how they feel the research relates to their own personal lives, so to give people a space to do that, **personal anecdotes are allowed as responses to this comment**. Any anecdotal comments elsewhere in the discussion will be removed and our [normal comment rules]( https://www.reddit.com/r/science/wiki/rules#wiki_comment_rules) apply to all other comments.
**Do you have an academic degree?** We can verify your credentials in order to assign user flair indicating your area of expertise. [Click here to apply](https://www.reddit.com/r/science/wiki/flair/).
---
User: u/mvea
Permalink: https://www.theguardian.com/science/article/2024/jul/03/study-possible-link-weight-loss-jabs-wegovy-ozempic-and-naion-condition-blindness
---
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/science) if you have any questions or concerns.*
I’ve linked to the news release in the post above. In this comment, for those interested, here’s the link to the peer reviewed journal article:
https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2820255
From the linked article:
Weight-loss jabs may be linked to condition that can cause blindness, study finds
People with diabetes on semaglutide, found in Wegovy and Ozempic, four times more likely to be diagnosed with disease of optic nerve
People who have been prescribed a weight-loss injection could be at a higher risk of developing an eye condition which can lead to blindness, a study has found.
The study found that people with diabetes who were prescribed semaglutide, most commonly known under the brand names Wegovy and Ozempic, were more than four times more likely to be diagnosed with an eye condition known as non-arteritic anterior ischemic optic neuropathy (naion).
Naion is a disorder in which the arteries which supply blood to the optic nerve in the eye become blocked. The condition can lead to loss of eyesight due to the optic nerve being deprived of oxygen and subsequently damaged. There is no known treatment for the condition, which affects 10 out of 100,000 people in the general population.
The research, published in the journal JAMA Ophthalmology and conducted by researchers at Harvard University, looked at data from 16,827 patients at the Mass Eye and Ear Harvard teaching hospital, who received treatment over a six-year period.
The problem with this is that it mentions people with diabetes getting the side effect, but then says people taking it for weight loss might be at risk. There's a \*ton\* of people taking these meds for weight loss at this point. Shouldn't the study reflect that?
The full study says they split them out into two cohorts to analyze separately: those taking it for type 2 diabetes and those taking it for overweight/obesity. So it looks like the study is reflecting the people taking it for weight loss, and their hazard ratio was even higher.
What I still haven't seen clarified is the difference in incidence between this and regular diabetic retinopathy.
Couldn't this just be that the drug isn't that effective in regulating BG and the frecuent blood spikes are developping into a retinopathy?
> Couldn't this just be that the drug isn't that effective in regulating BG and the frecuent blood spikes are developping into a retinopathy?
Retinopathy is tissue damage caused by excessive bleeding; usually from rupture of tiny blood vessels in the eye, caused by elevated blood sugar allowing crystals to form in the blood, causing the vision to be physically occluded. So in retinopathy, the optic nerve is undamaged, but the input is physically impaired. NAION causes a **lack** of blood flow to the optic nerve, resulting in ganglion cell death. In this case the portion of the eye allowing light in is undamaged, and some of the processing nerves have died.
NAION is neuropathy, it's just not retinopathy because it's not in the retina, as you said.
Diabetes has numerous neuropathies associated with it, not just retinopathy. It's also associated with increased risk for NAION as well, even though retinopathy is very common.
> Couldn't this just be that the drug isn't that effective in regulating BG and the frecuent blood spikes are developping into a retinopathy?
This was the question I was answering.
Right, but it sounds like they were actually asking if diabetic neuropathy could also increase the chance of NAION, which it can be.
The researchers did also find alarmingly higher incidence in obese patients also on semaglutide, so it sounds like there is an independent effect also at play though.
> Right, but it sounds like they were actually asking if diabetic neuropathy could also increase the chance of NAION, which it can be.
We won't know for certain until after years of testing. That said;
> The researchers did also find alarmingly higher incidence in obese patients also on semaglutide, so it sounds like there is an independent effect also at play though.
That seems to indicate an independent effect, at least at this juncture, using the data we actually have.
No, we already know that diabetic neuropathy puts diabetics at risk for NAION. It does. It's not as common as diabetic retinopathy, but diabetes (regardless of medication) does put someone at a higher risk of developing NAION than a non-diabetic.
The potential independent effect of semaglutide is what we're looking at now, but yes, the data in this meta-analysis seems to indicate there may well be one, so we'll see.
To be fair, my question was more oriented to wether these cases were truely an outlier caused by the drug or is they could be explained by regular diabetes damage
I mean if you look at the control group its still a significant increase. "over 36 months was 8.9% (95% CI, 4.5%-13.1%) and 1.8% (95% CI, 0%-3.5%), respectively."
7.1% increase against the control group for taking the drug while being diagnosed with type 2 diabetes.
Yes but these are relative numbers and not absolute numbers.
If this happens 10 times in 100,000 people and in the effected group it happens 15 times in 100,000 it is technically a 50% increased risk… but it’s only only 5/100,000 more people.
This is still a rare disease… (edited for typos)
Yeah, they found a significantly increased risk for overweight/obese pts on semaglutide as well (which is what you're referring to as the control group, right? I did look at the abstract, but earlier today).
I'm interested to read the full article, I'll see if I have access to it tomorrow.
Others have weighed in, but I've had retina surgery for this so thought I'd add a thought.
Diabetic retinopathy involves your eyes growing new, weak blood vessels to compensate for chronic inflammation and poor circulation. When these blood vessels pop, they create scar tissue along the retina which pull on it and can cause tractional detachment.
It sounds like the mechanism being described here is different, blocking (?) the blood vessels more directly and suffocating the organ rather than pulling it apart
Possibly because people with type II would have their NAION mis-classified as diabetic neuropathy/retinopathy, which has a similar symptom pattern and onset.
Diabetes also increases your chance of getting NAION, which is also a neuropathy. Less typical than retinopathy, but still, diabetes puts someone at increased risk.
This is interesting given that an [earlier meta-analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786911/) had suggested that subjects with T2D have an increased risk of developing NAION.
In this article, number of T2D subjects that develop NAION with GLP1-analog is 17 (6 for non-GLP1) while those who are obese with GLP1-analog that develop NAION is 20 (3 for non-GLP1).
I wonder what’s the incidence of diabetic retinopathy (DR) in subjects with T2D taking GLP-1 analog(s).
Also b12 deficiency can negatively impact your optic nerve, and so people who lose weight rapidly without tracking their vitamins can become deficient.
The study looked at data over 3 years for it. It likely hasn't been long enough for them to study and see if it matches with the general population. But with all the people taking it now, the test subjects are lined up for it.
So, I don't like that they didnt link to the study, but the guardian did a fairly good job explaining the conditions here, First thing to understand is that it's a meta analysis meaning, the study just looked at masses of data, and drew lines that seem to connect.
So there's broad correlations here but there's no double-blind-age controlled, condition controlled situations here, there's no baseline taken and there are no other isolated factors presented here.
That being said meta analysis are often our first clcues into looking for issues like this.
What the study says is it went through two groups of people, explicitly mentioned by % is the 1.8% of the diabetic group not on the semaglutide drugs vs the 8.9% on the drug, and the second explicit number is those not diabetic where 6.7% on the drug as opposed to .8% without the drug.
Diabetes on its own is a risk factor for naion events (non-arteritic anterior ischemic optic neuropathy)
but this is a whole other level. Likely it's going to spur further studies as manufacturers would want to isolate the exact % and try to show that it's lower... there could be other factors much more significant at play, perhaps some who developed the naion events were much more obese than the groups that didn't etc. maybe there's a dietary component or secondary illness. They do need a controlled study to isolate variables and come up with a better percentage.
I would think that any situation where doctors could say, "I understand you want this medicine but 1 in 20 will lose some vision or go blind from it" is absolutely untenable for the drug companies making these things.
I apologize, I haven't been able to fully review the source material. It's not actually a 1/20 risk, is it? This seems like a fairly rare disease in the overall human cohort, I have not heard of the neuropathy form before despite some medical knowledge and work. I would not have thought a 4x increase in incidence rate would yield anything more than a marginal, perhaps only slightly more than marginal risk.
I dont like that they spurred panic about a useful treatment without presenting it realistically or with any proper controls. Does anyone honestly think someone with completely untreated diabetes/obesity would be better off? That shouldve been the primary consideration. So far glp-1 agonists address the underlying cause more efficiently and effectively than any other drug or even lifestyle modification. The alternative is prolonged untreated/under-treated obesity which is essentially guaranteed to have worse outcomes.
How this is being presented is that glp-1’s are more dangerous than the conditions that warrant their prescription in the first place which is so backwards.
People with vascular risk factors are more at risk. It’s a devastating disease to be sure, but I don’t think you can make any big conclusions u less the study looked at healthy individuals using the medication.
I have been jabbed in the face before and I'd rather have a jab than be shot.
Edit - Thought I'd add that I have obviously also had someone shoot over my face and I retract my previous statement.
Hey we don’t use that in Canada, we say shots, and I see Americans can them jabs. As the person said I guess saying injection would be best.
When I think jab I think blunt poke not actually breaking skin. Regardless shot and jab are both slang and not official terms
Am I correct that they're comparing the rates of people with diabetes taking semaglutide with the condition against the rate of people with the condition in the general population? Because diabetes itself increases your chances of neuropathy...
Of course the study itself says further research would need to be done to suggest causality.
You’re incorrect, on both counts.
Rates were compared between those with diabetes on semaglutide vs those with diabetes on other disease controlling meds. This was probably fairly safe to infer given it’s a study conducted by Harvard published in JAMA, but you could also just read the guardian article.
And diabetic retinopathy is a completely separate pathophysiologic process.
No, they seem to be comparing it to within the population of diabetics. Other diabetics on different weight loss drugs did not seem to have as high a rate as this particular drug.
>Over three years, 6.7% of these people on semaglutide had naion compared with 0.8% who were taking other weight-loss drugs.
It doesn’t look like it was in the general population, but instead they matched them to people who were seen at that specific clinic who were similar to them in things like sex, age, hypertension, sleep apnea, coronary artery disease, etc.
"That specific clinic" is probably the most advanced health care facility on the planet. The prescribers there are aware of GLP-1 antagonists and the patients have them available, so presumably there were systematic differences between those who were prescribed GLP1s and those who weren't. Those differences may have been correlated to the observed outcomes.
And more advanced/poorly controlled diabetes with more extreme obesity is also more highly associated with GLP-1 inhibitors.
Obesity itself is also associated with optic nerve neuropathy, IIH, etc. And obesity is also correlated with GLP-1 use without T2D.
Even with regressions, it seems hard to entirely tease these associations apart. The actual paper itself admits this, and in the conclusion itself agrees more work is required to determine causality.
So funny that you mention IIH - I was diagnosed with it today and this is the first time I’ve ever seen it referred to in print outside of an article or study.
"Design, Setting, and Participants
In a retrospective matched cohort study using data from a centralized data registry of patients evaluated by neuro-ophthalmologists at 1 academic institution from December 1, 2017, through November 30, 2023, a search for International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code H47.01 (ischemic optic neuropathy) and text search yielded 16 827 patients with no history of NAION.
Propensity matching was used to assess whether prescribed semaglutide was associated with NAION in patients with type 2 diabetes (T2D) or overweight/obesity, in each case accounting for covarying factors (sex, age, systemic hypertension, T2D, obstructive sleep apnea, obesity, hyperlipidemia, and coronary artery disease) and contraindications for use of semaglutide.
The cumulative incidence of NAION was determined with the Kaplan-Meier method and a Cox proportional hazards regression model adjusted for potential confounding comorbidities. Data were analyzed from December 1, 2017, through November 30, 2023."
I've seen a neuro-opthamologist for issues relating to an injury. I'm in a major city, have good insurance, and it's still a LONG wait with maybe a dozen practitioners in my city. The fact that these people were in a data registry of patients evaluated by a neuro-opthamologist means they are distinct from people with diabetes who have not seen a neuro-opthamologist. It's interesting, but it definitely needs more research. Is it possible that, for someone with existing types of eye issues, rapid weight loss itself - or the mechanism of action that GLP-1 meds have - could exacerbate those issues? Idk. But that possibility was my main takeaway.
>The study found that people with diabetes who were prescribed semaglutide, most commonly known under the brand names Wegovy and Ozempic, were more than four times more likely to be diagnosed with an eye condition known as non-arteritic anterior ischemic optic neuropathy (naion).
Four times more than what? People with diabetes but different medication? People without diabetes? If I remember correctly diabetes by itself can cause blindness.
It’s for one clinic in Boston, it looks like. They broke it up into two cohorts: those taking it for type 2 diabetes and those taking it for weight loss. Then they broke each of those into taking semaglutide vs not (or specifically no exposure to this type of medication), and looked at who had the optic neuropathy. It looks like they tried to adjust for things like hypertension, type 2 diabetes, sleep apnea, etc. It looks like the hazard ratio of 4 was for the type 2 diabetes cohort. It was actually over 7 for the overweight/obese cohorts. It was limited to one clinic, so that might be influencing it, but the numbers are pretty significant.
I mean 20 NAION events occurred in the (non-t2d) semaglutide group vs 3 in the non-semaglutide group/979 patients seen at the clinic. The trouble is that you’re looking at a population at a neuro-ophthalmic clinic, so not great generalizability there.
I cant access the whole article. But in the part I can access they claim that there was higher risk also in the non diabetic group? Can you access what it was? Im guessing it was less than 4 times mire as they dont mention it in the abstracts.
The article says different medications:
>Over three years, 6.7% of these people on semaglutide had naion compared with 0.8% who were taking other weight-loss drugs.
Risky business to make this kind of study. Diabetic patients are at increased risk of eye related changes (usually artery related issues) however it can cause varying degrees of drusen as well.
But to look at patients, with the disease (diabetes) and the exposure (semaglutide) and follow them for non-arteritic ischemic eye changes seems like a big bias problem. Even with matched controls it raises some questions about selection bias.
So, from 1 in 10000 to 4 in 10000. For comparison: as far as I remember, getting a thorax X-Ray has about a 1 in 10000 likelyhood of giving you cancer.
Does this have anything to do with the increased chance of retinopathy associated with a rapid drop in blood glucose? The real problem (in that case) is that the person has a massively high blood sugar, the body has gotten used to it, and then Ozempic is injected (which works a little too well) and causes a drop of blood sugar. The blood sugar doesn’t drop to dangerous ranges (to most people), but for a severe diabetic whose body is used to a higher blood sugar, the drop can be too fast and cause damage .
This is a different condition from diabetic retinopathy, it is optic nerve neuropathy. A followup study will have to see if it is actually increasing the likelihood of this condition, or if the condition itself hits the sample population at around the same rates generally, as obesity itself is known to cause optic nerve neuropathy.
I was at the convention for the release of ozempic. (Working it as the help) and in one of the meetings they said there was a slight risk for this. Totally downplayed it. They knew about the risk before they released it. It’s in their test results when developing the drug.
I hope this isn't lost. This is EXACTLY what happened to my friend a day after starting Wegovy. He went partially blind for 4 days (he recovered 100% after treatment and adjusting medication). Patients are supposed to be made aware of this side effect and go to the emergency room if this occurs.
This is what I was looking for. A 4x 0.1% chance is only 0.4%. Not sure what the actual chances are here but anytime I see “4 times more likely” I get really skeptical.
Im convinced most of these studies are posted by people that dont know that, much like conspiracy theorists, post because they feel like they are exposing truth.
Its important information and should be studied further, but its useless information to the public, like a huge amount of low size studies that seem to plague this subreddit.
Yeah it kinda took on its own life in the US, whenever you hear the term 'jab' here it's like a 95% chance they're antivax. Seems to happen to a lot of terms used in insular groups, worst offender in the other direction is probably "same-sex attracted" getting lifted into the UK's vocabulary from the US's Christian-extremist conversion therapy groups.
Good thing that the actual scientific study doesn't use that word then, because the headline is from is from **a newspaper writeup of the scientific study**.
I mean that logic is sound at times, but some things that people considered luxury, difficult or even impossible back in the day is as normal as the sun going up every day. Having frozen food available at any moment with a microwave using very little electricity? Or being able to drink clean water by going up to your sink (at least in Sweden). There are many medicines without significant side effects, but this is a (from a laymans perspective) complex issue, and the human body is even more complex, making the problem solving a truly gargantuan task.
Yes but there are carbon neutral and even carbon positive projects going on. While it is not feasible today that we run the world carbon neutrally and keep the same living standards, it is definitely within reach if things keep improving. (Now of course, new things will pop up that humans will want, and will require more resources to maintain, but that is also a problem that will get solved and the cycle continues).
The KM curves in Figure 2 separate immediately, and then all separation occurs between 6 and 12 months.
This “effect” seems most likely study design bias, not a biological effect, but the methods don’t give enough detail to determine this for sure.
Specifically, collider bias, where associations are induced by selection of the cohort on 'referral to neuro-opthalmologist'. Both obesity/diabetes treated with semaglutide and risk of NAION are presumably associated with being seen in this clinic, potentially leading to spurious associations. Interestingly, for this to be true and for the direction of bias to line up, the neuro-ophthalmology clinic will have excluded diabetic retinopathy as a referral reason (not clear in the study methods).
>Included in the study were 975 patients who were overweight or living with obesity, with 361 of these having been prescribed semaglutide.
>Of the people included in the study with type 2 diabetes, 17 naion events occurred in patients who were prescribed semaglutide, compared with six who were on other diabetes drugs.
So, out of nearly 1000 people, 23 total had the condition. Regardless of the distribution between the two groups, it's not enough to determine correlation, much less causation. Everyone take a deep breath.
Of course it is enough, especially if the condition is otherwise rare enough in these cohorts so that the difference in incidence is significant. You can't just dismiss a 2.3% rate as not enough with no context, that's a massive number for *going blind*
Very 'click bait' and dissapointing for the Guardian and as the authors of the study state, "This study’s findings suggest an association between semaglutide and NAION. As this was an observational study, future study is required to assess causality."
Also, purely IMHO, from the extract only, as I do not have access to the full paper, it feels a bit 'give me research money' to me.
Anyway, off to find my glasses and then my fat jab.
> "This study’s findings suggest an association between semaglutide and NAION. As this was an observational study, future study is required to assess causality."
Yes, and those future studies are now possible now that this one has identified a potential risk.
This is the takeaway.
This drug has been shown to manage and prevent diabetes, which is in itself a leading cause of blindness. The increased risk is only with a specific complication, not just blindness in general.
Edit: typo
Acquired ~~blondness~~ blindless (as opposed to inherited) is an increasingly prevalent issue in modern society that needs to be taken more seriously. My grandfather on my mother's side of the family was recently diagnosed as diabetic at 81 years old, but within a year his blood glucose levels dropped to almost normal via a strict low-sodium, low-carb, and mostly vegetarian diet + daily exercise. Gives me hope for the future despite having diabetes on both sides of the family as my diet is clean and I work out regularly. Hopefully that'll be enough to stave it off.
Edit: typo
So my odds of developing this go from 0.01% to 0.04%.
Vs odds of heart disease from being a fat ass?
I'm going to take the shot, I have been taking the shot, and it's been helping.
About 20% drop in cardiac death rates at a population level based on past studies. A significant percentage of that was independent of weight loss. Seems worth it
I'd also be curious how if any the people in the non-T2D group who got this condition varied from those who didn't. Are there other correlations across those groups, like perhaps the group that is on semaglutide being more overweight than the group that is on other weight loss medications? Would make sense if they were given the expense of semaglutide.
The study linking weight-loss injections like semaglutide to a higher risk of optic nerve disease among people with diabetes is concerning. It underscores the importance of thorough medical monitoring and informed decision-making when considering treatments. For those managing diabetes, the potential risks and benefits of medications like Wegovy and Ozempic should be carefully weighed in consultation with healthcare providers.
Is it me or does it feel like the public has been on an assault against semaglutide ever since it became obvious that it works? Why are people so appalled by effective weight loss medication?
there's a significant number of people who want to treat obesity as a moral failing and thus want to consider treating it with a medication as an extension of that moral failing. A lot of it is also that these people like to feel superior to those who are overweight and they don't like feeling that they could lose that.
In Germany doctors are only allowed to prescribe it to diabetic or extremely obese people, but because of the hype a lot of normal and slightly obese people got doctors to prescribe it to them or found other illegal ways to get it. That resulted in a shortage resulting in diabetic patients that where not able to get their medication. So doing illegal stuff + ill people can't get their meds, that's a very easy bogeyman. Obviously there are also other reasons for the stigma, but at least here this was a huge contributing factor and very present in the media.
NAION has a specific risk factor related to the size of the optic nerve head (ONH). Apparently a crowded ONH can lead to loss of circulation or oxygenation under certain (rare) circumstances.
So, I did a simple statistical analysis. The data on NAION is that 95-97% of cases have optic nerve cup-to-disc ratios less than 0.2 (some have said 0.3). That doesn't mean that having this physical condition makes the risk super high, but probably higher, depending on the distribution of optic nerve cup to disc ratios in the population.
This begs two questions. 1) What’s the probability distribution of different disc to cup ratios, and 2) what does this say about your odds of contracting NAION (with or without semaglutide) based on being above or below 0.2.? This presupposes that the correlation in the semaglutide study has some causal basis that is correctly reflected in the risk ratios mentioned (that's hard to work out and will take time). You might further hypothesize that semaglutide aggravates the existing predisposition based on optic nerve structure rather than being a totally independent effect. Maybe or maybe not, but it might be straightforward to get at with an eye exam of the people in the study who contracted NAION. It might be in the medical records already.
Now to some analysis. I’m aware of two studies of (mostly white) people that show the mean cup to disc ratio is 0.36-0.49 with a standard deviation of 0.13-0.14. This makes people with a cup to disc ratio of less than 0.2 between 2% and 11% of the population and people with a ratio less than 0.3 between 9% and 32% of the population. There are almost certainly age-related variations in all this data that I am glossing over as secondary, but the fact that the percentages of people with small ratios is small couples with the very high percentage of NAION cases having a small ratio makes the data meaningful.
The overall results of the just-released study show that the 7x increase in risk of NAION that would take the entire population from a 10 per 100,000 probability to a 74 per 100,000 probability - or 0.07%. That's small regardless, though I am unclear about the time period for these statistics - is it annual or lifetime or something else?
Regardless of the timeframe, if that higher risk level is contained almost entirely within the subset of people with small cup to disc ratios then the odds of NAION within this population go up - to somewhere between 0.2% and 3.7% depending on which "at risk" cup to disc ratio and which population study you are looking at. Conversely, it would reduce the risk for everyone else - those with larger than 0.2-0.3 cup to disc ratios - by a factor of 20-33 (1/0.95 to 1/0.97). That's odds of 0.002% - 0.004%. That’s effectively zero. So a lot hangs on whether the effect described in the study changes the odds for people with larger optic nerve cup to disc ratios or it mostly exacerbates the existing predisposition. Seems like figuring that out would be a great service to a large number of people.
Of course all of the above is built on a set of assumptions and I am not a doctor or ophthalmologist or medical researcher - so talk to your doctor(s).
How about contrasting the potential unknown issues of the weight loss medications against the **known** issues of chronic long term obesity? It's an absolute no brainier what the winner here is and these medications which absolutely work should be heralded for what they do
Within the GLP-1 community most people find they have many more noticeable daily side effects from semaglutide with a smaller payoff. I'd like to see what they find out about tirzepatide. I went with that option because it seemed gentler on the system and more effective.
Welcome to r/science! This is a heavily moderated subreddit in order to keep the discussion on science. However, we recognize that many people want to discuss how they feel the research relates to their own personal lives, so to give people a space to do that, **personal anecdotes are allowed as responses to this comment**. Any anecdotal comments elsewhere in the discussion will be removed and our [normal comment rules]( https://www.reddit.com/r/science/wiki/rules#wiki_comment_rules) apply to all other comments. **Do you have an academic degree?** We can verify your credentials in order to assign user flair indicating your area of expertise. [Click here to apply](https://www.reddit.com/r/science/wiki/flair/). --- User: u/mvea Permalink: https://www.theguardian.com/science/article/2024/jul/03/study-possible-link-weight-loss-jabs-wegovy-ozempic-and-naion-condition-blindness --- *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/science) if you have any questions or concerns.*
I’ve linked to the news release in the post above. In this comment, for those interested, here’s the link to the peer reviewed journal article: https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2820255 From the linked article: Weight-loss jabs may be linked to condition that can cause blindness, study finds People with diabetes on semaglutide, found in Wegovy and Ozempic, four times more likely to be diagnosed with disease of optic nerve People who have been prescribed a weight-loss injection could be at a higher risk of developing an eye condition which can lead to blindness, a study has found. The study found that people with diabetes who were prescribed semaglutide, most commonly known under the brand names Wegovy and Ozempic, were more than four times more likely to be diagnosed with an eye condition known as non-arteritic anterior ischemic optic neuropathy (naion). Naion is a disorder in which the arteries which supply blood to the optic nerve in the eye become blocked. The condition can lead to loss of eyesight due to the optic nerve being deprived of oxygen and subsequently damaged. There is no known treatment for the condition, which affects 10 out of 100,000 people in the general population. The research, published in the journal JAMA Ophthalmology and conducted by researchers at Harvard University, looked at data from 16,827 patients at the Mass Eye and Ear Harvard teaching hospital, who received treatment over a six-year period.
The problem with this is that it mentions people with diabetes getting the side effect, but then says people taking it for weight loss might be at risk. There's a \*ton\* of people taking these meds for weight loss at this point. Shouldn't the study reflect that?
The full study says they split them out into two cohorts to analyze separately: those taking it for type 2 diabetes and those taking it for overweight/obesity. So it looks like the study is reflecting the people taking it for weight loss, and their hazard ratio was even higher.
Ah, ok. That makes sense then.
What I still haven't seen clarified is the difference in incidence between this and regular diabetic retinopathy. Couldn't this just be that the drug isn't that effective in regulating BG and the frecuent blood spikes are developping into a retinopathy?
> Couldn't this just be that the drug isn't that effective in regulating BG and the frecuent blood spikes are developping into a retinopathy? Retinopathy is tissue damage caused by excessive bleeding; usually from rupture of tiny blood vessels in the eye, caused by elevated blood sugar allowing crystals to form in the blood, causing the vision to be physically occluded. So in retinopathy, the optic nerve is undamaged, but the input is physically impaired. NAION causes a **lack** of blood flow to the optic nerve, resulting in ganglion cell death. In this case the portion of the eye allowing light in is undamaged, and some of the processing nerves have died.
NAION is neuropathy, it's just not retinopathy because it's not in the retina, as you said. Diabetes has numerous neuropathies associated with it, not just retinopathy. It's also associated with increased risk for NAION as well, even though retinopathy is very common.
> Couldn't this just be that the drug isn't that effective in regulating BG and the frecuent blood spikes are developping into a retinopathy? This was the question I was answering.
Right, but it sounds like they were actually asking if diabetic neuropathy could also increase the chance of NAION, which it can be. The researchers did also find alarmingly higher incidence in obese patients also on semaglutide, so it sounds like there is an independent effect also at play though.
> Right, but it sounds like they were actually asking if diabetic neuropathy could also increase the chance of NAION, which it can be. We won't know for certain until after years of testing. That said; > The researchers did also find alarmingly higher incidence in obese patients also on semaglutide, so it sounds like there is an independent effect also at play though. That seems to indicate an independent effect, at least at this juncture, using the data we actually have.
No, we already know that diabetic neuropathy puts diabetics at risk for NAION. It does. It's not as common as diabetic retinopathy, but diabetes (regardless of medication) does put someone at a higher risk of developing NAION than a non-diabetic. The potential independent effect of semaglutide is what we're looking at now, but yes, the data in this meta-analysis seems to indicate there may well be one, so we'll see.
To be fair, my question was more oriented to wether these cases were truely an outlier caused by the drug or is they could be explained by regular diabetes damage
I mean if you look at the control group its still a significant increase. "over 36 months was 8.9% (95% CI, 4.5%-13.1%) and 1.8% (95% CI, 0%-3.5%), respectively." 7.1% increase against the control group for taking the drug while being diagnosed with type 2 diabetes.
Yes but these are relative numbers and not absolute numbers. If this happens 10 times in 100,000 people and in the effected group it happens 15 times in 100,000 it is technically a 50% increased risk… but it’s only only 5/100,000 more people. This is still a rare disease… (edited for typos)
Yeah, they found a significantly increased risk for overweight/obese pts on semaglutide as well (which is what you're referring to as the control group, right? I did look at the abstract, but earlier today). I'm interested to read the full article, I'll see if I have access to it tomorrow.
This is what I was wondering too but I didn’t read the whole study. They may have adjusted for that.
Others have weighed in, but I've had retina surgery for this so thought I'd add a thought. Diabetic retinopathy involves your eyes growing new, weak blood vessels to compensate for chronic inflammation and poor circulation. When these blood vessels pop, they create scar tissue along the retina which pull on it and can cause tractional detachment. It sounds like the mechanism being described here is different, blocking (?) the blood vessels more directly and suffocating the organ rather than pulling it apart
Possibly because people with type II would have their NAION mis-classified as diabetic neuropathy/retinopathy, which has a similar symptom pattern and onset.
Diabetes also increases your chance of getting NAION, which is also a neuropathy. Less typical than retinopathy, but still, diabetes puts someone at increased risk.
I know, but as the others are more common (and have similar sx, if not causes) I would expect more mis-classified cases of NAION.
This is interesting given that an [earlier meta-analysis](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786911/) had suggested that subjects with T2D have an increased risk of developing NAION. In this article, number of T2D subjects that develop NAION with GLP1-analog is 17 (6 for non-GLP1) while those who are obese with GLP1-analog that develop NAION is 20 (3 for non-GLP1). I wonder what’s the incidence of diabetic retinopathy (DR) in subjects with T2D taking GLP-1 analog(s).
This is especially crazy given that loss of vision is incredibly common *already* for individuals with diabetes.
Kidney issues too! It’s all those small little blood vessel areas that are problems.
Also b12 deficiency can negatively impact your optic nerve, and so people who lose weight rapidly without tracking their vitamins can become deficient.
The study looked at data over 3 years for it. It likely hasn't been long enough for them to study and see if it matches with the general population. But with all the people taking it now, the test subjects are lined up for it.
So, I don't like that they didnt link to the study, but the guardian did a fairly good job explaining the conditions here, First thing to understand is that it's a meta analysis meaning, the study just looked at masses of data, and drew lines that seem to connect. So there's broad correlations here but there's no double-blind-age controlled, condition controlled situations here, there's no baseline taken and there are no other isolated factors presented here. That being said meta analysis are often our first clcues into looking for issues like this. What the study says is it went through two groups of people, explicitly mentioned by % is the 1.8% of the diabetic group not on the semaglutide drugs vs the 8.9% on the drug, and the second explicit number is those not diabetic where 6.7% on the drug as opposed to .8% without the drug. Diabetes on its own is a risk factor for naion events (non-arteritic anterior ischemic optic neuropathy) but this is a whole other level. Likely it's going to spur further studies as manufacturers would want to isolate the exact % and try to show that it's lower... there could be other factors much more significant at play, perhaps some who developed the naion events were much more obese than the groups that didn't etc. maybe there's a dietary component or secondary illness. They do need a controlled study to isolate variables and come up with a better percentage. I would think that any situation where doctors could say, "I understand you want this medicine but 1 in 20 will lose some vision or go blind from it" is absolutely untenable for the drug companies making these things.
I apologize, I haven't been able to fully review the source material. It's not actually a 1/20 risk, is it? This seems like a fairly rare disease in the overall human cohort, I have not heard of the neuropathy form before despite some medical knowledge and work. I would not have thought a 4x increase in incidence rate would yield anything more than a marginal, perhaps only slightly more than marginal risk.
Seems more like 1/2000
I dont like that they spurred panic about a useful treatment without presenting it realistically or with any proper controls. Does anyone honestly think someone with completely untreated diabetes/obesity would be better off? That shouldve been the primary consideration. So far glp-1 agonists address the underlying cause more efficiently and effectively than any other drug or even lifestyle modification. The alternative is prolonged untreated/under-treated obesity which is essentially guaranteed to have worse outcomes. How this is being presented is that glp-1’s are more dangerous than the conditions that warrant their prescription in the first place which is so backwards.
Have people been taking it for weight loss long enough to see the effect?
Or not-see the effect, as it were.
As I understand it you use a much higher dose for weight loss than for diabetes management, too.
I mean if it’s not in their scope, why would it reflect that?
The people taking it for weight loss are taking more than double the dose as well. 1mg vs. 2.4mg subq weekly.
People with vascular risk factors are more at risk. It’s a devastating disease to be sure, but I don’t think you can make any big conclusions u less the study looked at healthy individuals using the medication.
My understanding is that it studied by groups and those taking it for weight loss have a higher risk
What about tirzepatide?
Wondering the same
Based off some googling it sounds like any GLP-1 agonist my elevate the risk.
So increased from 0.01% to 0.04%, which is 7 participants?
Yep. That’s not exactly 1 in 20
Got I hate them being called jabs, call them shots!
Or injections, maybe even subcutaneous injections since that's what they are
I have been jabbed in the face before and I'd rather have a jab than be shot. Edit - Thought I'd add that I have obviously also had someone shoot over my face and I retract my previous statement.
You hate British/Commonwealth English? *The nerve* of The Guardian, one of Britain's leading newspapers, not using American English!
Hey we don’t use that in Canada, we say shots, and I see Americans can them jabs. As the person said I guess saying injection would be best. When I think jab I think blunt poke not actually breaking skin. Regardless shot and jab are both slang and not official terms
Am I correct that they're comparing the rates of people with diabetes taking semaglutide with the condition against the rate of people with the condition in the general population? Because diabetes itself increases your chances of neuropathy... Of course the study itself says further research would need to be done to suggest causality.
You’re incorrect, on both counts. Rates were compared between those with diabetes on semaglutide vs those with diabetes on other disease controlling meds. This was probably fairly safe to infer given it’s a study conducted by Harvard published in JAMA, but you could also just read the guardian article. And diabetic retinopathy is a completely separate pathophysiologic process.
I mentioned this study to my wife (doctor) saying about the same thing /u/cubsfan85 said above and got essentially the same response from her, haha.
No, they seem to be comparing it to within the population of diabetics. Other diabetics on different weight loss drugs did not seem to have as high a rate as this particular drug. >Over three years, 6.7% of these people on semaglutide had naion compared with 0.8% who were taking other weight-loss drugs.
It doesn’t look like it was in the general population, but instead they matched them to people who were seen at that specific clinic who were similar to them in things like sex, age, hypertension, sleep apnea, coronary artery disease, etc.
"That specific clinic" is probably the most advanced health care facility on the planet. The prescribers there are aware of GLP-1 antagonists and the patients have them available, so presumably there were systematic differences between those who were prescribed GLP1s and those who weren't. Those differences may have been correlated to the observed outcomes.
And more advanced/poorly controlled diabetes with more extreme obesity is also more highly associated with GLP-1 inhibitors. Obesity itself is also associated with optic nerve neuropathy, IIH, etc. And obesity is also correlated with GLP-1 use without T2D. Even with regressions, it seems hard to entirely tease these associations apart. The actual paper itself admits this, and in the conclusion itself agrees more work is required to determine causality.
So funny that you mention IIH - I was diagnosed with it today and this is the first time I’ve ever seen it referred to in print outside of an article or study.
"Design, Setting, and Participants In a retrospective matched cohort study using data from a centralized data registry of patients evaluated by neuro-ophthalmologists at 1 academic institution from December 1, 2017, through November 30, 2023, a search for International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code H47.01 (ischemic optic neuropathy) and text search yielded 16 827 patients with no history of NAION. Propensity matching was used to assess whether prescribed semaglutide was associated with NAION in patients with type 2 diabetes (T2D) or overweight/obesity, in each case accounting for covarying factors (sex, age, systemic hypertension, T2D, obstructive sleep apnea, obesity, hyperlipidemia, and coronary artery disease) and contraindications for use of semaglutide. The cumulative incidence of NAION was determined with the Kaplan-Meier method and a Cox proportional hazards regression model adjusted for potential confounding comorbidities. Data were analyzed from December 1, 2017, through November 30, 2023." I've seen a neuro-opthamologist for issues relating to an injury. I'm in a major city, have good insurance, and it's still a LONG wait with maybe a dozen practitioners in my city. The fact that these people were in a data registry of patients evaluated by a neuro-opthamologist means they are distinct from people with diabetes who have not seen a neuro-opthamologist. It's interesting, but it definitely needs more research. Is it possible that, for someone with existing types of eye issues, rapid weight loss itself - or the mechanism of action that GLP-1 meds have - could exacerbate those issues? Idk. But that possibility was my main takeaway.
It did split out a subpopulation of diabetics with the eye condition who were and were not taking semaglutide
>The study found that people with diabetes who were prescribed semaglutide, most commonly known under the brand names Wegovy and Ozempic, were more than four times more likely to be diagnosed with an eye condition known as non-arteritic anterior ischemic optic neuropathy (naion). Four times more than what? People with diabetes but different medication? People without diabetes? If I remember correctly diabetes by itself can cause blindness.
It’s for one clinic in Boston, it looks like. They broke it up into two cohorts: those taking it for type 2 diabetes and those taking it for weight loss. Then they broke each of those into taking semaglutide vs not (or specifically no exposure to this type of medication), and looked at who had the optic neuropathy. It looks like they tried to adjust for things like hypertension, type 2 diabetes, sleep apnea, etc. It looks like the hazard ratio of 4 was for the type 2 diabetes cohort. It was actually over 7 for the overweight/obese cohorts. It was limited to one clinic, so that might be influencing it, but the numbers are pretty significant.
I mean 20 NAION events occurred in the (non-t2d) semaglutide group vs 3 in the non-semaglutide group/979 patients seen at the clinic. The trouble is that you’re looking at a population at a neuro-ophthalmic clinic, so not great generalizability there.
I cant access the whole article. But in the part I can access they claim that there was higher risk also in the non diabetic group? Can you access what it was? Im guessing it was less than 4 times mire as they dont mention it in the abstracts.
Going off memory, but it was actually way higher: 7.64 for the people without diabetes who were taking it for weight loss.
The article says different medications: >Over three years, 6.7% of these people on semaglutide had naion compared with 0.8% who were taking other weight-loss drugs.
Risky business to make this kind of study. Diabetic patients are at increased risk of eye related changes (usually artery related issues) however it can cause varying degrees of drusen as well. But to look at patients, with the disease (diabetes) and the exposure (semaglutide) and follow them for non-arteritic ischemic eye changes seems like a big bias problem. Even with matched controls it raises some questions about selection bias.
Four times more likely than who? Diabetics are at higher risk of circulatory problems resulting in blindness in the first place.
As a diabetic myself, diabetics have a high risk for eye disease and blindness already.
So, from 1 in 10000 to 4 in 10000. For comparison: as far as I remember, getting a thorax X-Ray has about a 1 in 10000 likelyhood of giving you cancer.
Does this have anything to do with the increased chance of retinopathy associated with a rapid drop in blood glucose? The real problem (in that case) is that the person has a massively high blood sugar, the body has gotten used to it, and then Ozempic is injected (which works a little too well) and causes a drop of blood sugar. The blood sugar doesn’t drop to dangerous ranges (to most people), but for a severe diabetic whose body is used to a higher blood sugar, the drop can be too fast and cause damage .
This is a different condition from diabetic retinopathy, it is optic nerve neuropathy. A followup study will have to see if it is actually increasing the likelihood of this condition, or if the condition itself hits the sample population at around the same rates generally, as obesity itself is known to cause optic nerve neuropathy.
I was at the convention for the release of ozempic. (Working it as the help) and in one of the meetings they said there was a slight risk for this. Totally downplayed it. They knew about the risk before they released it. It’s in their test results when developing the drug.
Then why doesn't this happen with any other medication that has more potent hypoglycemic action?
The diabetic retinopathy thing? Happens with insulin as well. The neuropathy thing I'm unsure of.
Exactly. Where are the studies on metformin?
I hope this isn't lost. This is EXACTLY what happened to my friend a day after starting Wegovy. He went partially blind for 4 days (he recovered 100% after treatment and adjusting medication). Patients are supposed to be made aware of this side effect and go to the emergency room if this occurs.
The power is incredibly low here, only 20 cases is crazy to conclude anything from. Worth monitoring but that’s about it.
This is what I was looking for. A 4x 0.1% chance is only 0.4%. Not sure what the actual chances are here but anytime I see “4 times more likely” I get really skeptical.
Im convinced most of these studies are posted by people that dont know that, much like conspiracy theorists, post because they feel like they are exposing truth. Its important information and should be studied further, but its useless information to the public, like a huge amount of low size studies that seem to plague this subreddit.
Aren’t people with diabetes *already* at risk for blindness?
I hate it when people use “jabs”
It's a British thing.
“It’s a jab scheme. I heard about it when I was in hospital.”
I was wondering when the hell “jab” became accepted as a synonym for “injection”
British-English
It was anti-vaccination political messaging about the COVID vaccine
It has been a commonly used term in the UK for decades. The author of the article is from the UK.
Yeah it kinda took on its own life in the US, whenever you hear the term 'jab' here it's like a 95% chance they're antivax. Seems to happen to a lot of terms used in insular groups, worst offender in the other direction is probably "same-sex attracted" getting lifted into the UK's vocabulary from the US's Christian-extremist conversion therapy groups.
Totally agree. This is a scientific study and the word "jab" in reference to an injection is totally idiotic.
Good thing that the actual scientific study doesn't use that word then, because the headline is from is from **a newspaper writeup of the scientific study**.
Why is it idiotic though? Seems pretty aggressive for a difference in language.
"jab" is a non technical / non scientific term that does not belong in a scientific discussion. You're free to disagree with me....
It has also gained popularity with anti-vaccination people to use in a mocking way.
There are probably many words we cant mention here then, which is likely only gating otherwise intelligent discussion.
Is it a scientific study? Or is it a newspaper article about a scientific study? The URL suggests the latter, which, yeah, British news is cray cray
You hate British/Commonwealth English? *The nerve* of The Guardian, one of Britain's leading newspapers, not using American English!
Yeah yeah, now gimme dat shot
Unless I see a blind Kardashian by the end of the year I'm taking this with a grain of salt.
I’m convinced a Genie created Ozempic. Want to look skinny? Sure but you won’t get to see it.
\*monkey paw finger curls\*
r/monkeyspaw
Sounds like an Ursula inspired deal.
Eh, in life nothing is for free.
I mean that logic is sound at times, but some things that people considered luxury, difficult or even impossible back in the day is as normal as the sun going up every day. Having frozen food available at any moment with a microwave using very little electricity? Or being able to drink clean water by going up to your sink (at least in Sweden). There are many medicines without significant side effects, but this is a (from a laymans perspective) complex issue, and the human body is even more complex, making the problem solving a truly gargantuan task.
(But also those things aren't for free either, the energy required for those things is causing climate change.)
Yes but there are carbon neutral and even carbon positive projects going on. While it is not feasible today that we run the world carbon neutrally and keep the same living standards, it is definitely within reach if things keep improving. (Now of course, new things will pop up that humans will want, and will require more resources to maintain, but that is also a problem that will get solved and the cycle continues).
And these GLP-1 receptor agonists are already *not* cheap at all monetarily speaking.
low dose zepbound + low dose HU6(prodrug) here we go.
Where'd you source HU6? How's the results?
This was my first thought when I read the title
The KM curves in Figure 2 separate immediately, and then all separation occurs between 6 and 12 months. This “effect” seems most likely study design bias, not a biological effect, but the methods don’t give enough detail to determine this for sure.
Specifically, collider bias, where associations are induced by selection of the cohort on 'referral to neuro-opthalmologist'. Both obesity/diabetes treated with semaglutide and risk of NAION are presumably associated with being seen in this clinic, potentially leading to spurious associations. Interestingly, for this to be true and for the direction of bias to line up, the neuro-ophthalmology clinic will have excluded diabetic retinopathy as a referral reason (not clear in the study methods).
I now have an explanation for why I was diagnosed with idiopathic NAION by a neuro-opthalmologist last year. I take Trulicity for T2. AMA, I guess?
You know what else makes you go blind? #DIABETES
>Included in the study were 975 patients who were overweight or living with obesity, with 361 of these having been prescribed semaglutide. >Of the people included in the study with type 2 diabetes, 17 naion events occurred in patients who were prescribed semaglutide, compared with six who were on other diabetes drugs. So, out of nearly 1000 people, 23 total had the condition. Regardless of the distribution between the two groups, it's not enough to determine correlation, much less causation. Everyone take a deep breath.
Of course it is enough, especially if the condition is otherwise rare enough in these cohorts so that the difference in incidence is significant. You can't just dismiss a 2.3% rate as not enough with no context, that's a massive number for *going blind*
Very 'click bait' and dissapointing for the Guardian and as the authors of the study state, "This study’s findings suggest an association between semaglutide and NAION. As this was an observational study, future study is required to assess causality." Also, purely IMHO, from the extract only, as I do not have access to the full paper, it feels a bit 'give me research money' to me. Anyway, off to find my glasses and then my fat jab.
Anyone can do that study. It’s not even interventional. It’s just having database access.
Yes, totally agree. Hopefully someone who access to the full paper and associated peer review, can enlighten us on its merits.
> "This study’s findings suggest an association between semaglutide and NAION. As this was an observational study, future study is required to assess causality." Yes, and those future studies are now possible now that this one has identified a potential risk.
This is the takeaway. This drug has been shown to manage and prevent diabetes, which is in itself a leading cause of blindness. The increased risk is only with a specific complication, not just blindness in general. Edit: typo
Acquired ~~blondness~~ blindless (as opposed to inherited) is an increasingly prevalent issue in modern society that needs to be taken more seriously. My grandfather on my mother's side of the family was recently diagnosed as diabetic at 81 years old, but within a year his blood glucose levels dropped to almost normal via a strict low-sodium, low-carb, and mostly vegetarian diet + daily exercise. Gives me hope for the future despite having diabetes on both sides of the family as my diet is clean and I work out regularly. Hopefully that'll be enough to stave it off. Edit: typo
Took me a bit to understand why you were talking so negatively about hair bleaching.
4x as likely to develop a very rare condition. Meanwhile, obesity is risk factor for 4 of the top 10 leading causes of death in the U.S.
Also the risk based on their numbers here is about 1/100
So my odds of developing this go from 0.01% to 0.04%. Vs odds of heart disease from being a fat ass? I'm going to take the shot, I have been taking the shot, and it's been helping.
About 20% drop in cardiac death rates at a population level based on past studies. A significant percentage of that was independent of weight loss. Seems worth it
I'd also be curious how if any the people in the non-T2D group who got this condition varied from those who didn't. Are there other correlations across those groups, like perhaps the group that is on semaglutide being more overweight than the group that is on other weight loss medications? Would make sense if they were given the expense of semaglutide.
The study linking weight-loss injections like semaglutide to a higher risk of optic nerve disease among people with diabetes is concerning. It underscores the importance of thorough medical monitoring and informed decision-making when considering treatments. For those managing diabetes, the potential risks and benefits of medications like Wegovy and Ozempic should be carefully weighed in consultation with healthcare providers.
its like a monkey's paw
Is it me or does it feel like the public has been on an assault against semaglutide ever since it became obvious that it works? Why are people so appalled by effective weight loss medication?
there's a significant number of people who want to treat obesity as a moral failing and thus want to consider treating it with a medication as an extension of that moral failing. A lot of it is also that these people like to feel superior to those who are overweight and they don't like feeling that they could lose that.
There definitely feels like there’s a stigma surrounding the use of GLP-1/GIP-type medications.
In Germany doctors are only allowed to prescribe it to diabetic or extremely obese people, but because of the hype a lot of normal and slightly obese people got doctors to prescribe it to them or found other illegal ways to get it. That resulted in a shortage resulting in diabetic patients that where not able to get their medication. So doing illegal stuff + ill people can't get their meds, that's a very easy bogeyman. Obviously there are also other reasons for the stigma, but at least here this was a huge contributing factor and very present in the media.
NAION has a specific risk factor related to the size of the optic nerve head (ONH). Apparently a crowded ONH can lead to loss of circulation or oxygenation under certain (rare) circumstances. So, I did a simple statistical analysis. The data on NAION is that 95-97% of cases have optic nerve cup-to-disc ratios less than 0.2 (some have said 0.3). That doesn't mean that having this physical condition makes the risk super high, but probably higher, depending on the distribution of optic nerve cup to disc ratios in the population. This begs two questions. 1) What’s the probability distribution of different disc to cup ratios, and 2) what does this say about your odds of contracting NAION (with or without semaglutide) based on being above or below 0.2.? This presupposes that the correlation in the semaglutide study has some causal basis that is correctly reflected in the risk ratios mentioned (that's hard to work out and will take time). You might further hypothesize that semaglutide aggravates the existing predisposition based on optic nerve structure rather than being a totally independent effect. Maybe or maybe not, but it might be straightforward to get at with an eye exam of the people in the study who contracted NAION. It might be in the medical records already. Now to some analysis. I’m aware of two studies of (mostly white) people that show the mean cup to disc ratio is 0.36-0.49 with a standard deviation of 0.13-0.14. This makes people with a cup to disc ratio of less than 0.2 between 2% and 11% of the population and people with a ratio less than 0.3 between 9% and 32% of the population. There are almost certainly age-related variations in all this data that I am glossing over as secondary, but the fact that the percentages of people with small ratios is small couples with the very high percentage of NAION cases having a small ratio makes the data meaningful. The overall results of the just-released study show that the 7x increase in risk of NAION that would take the entire population from a 10 per 100,000 probability to a 74 per 100,000 probability - or 0.07%. That's small regardless, though I am unclear about the time period for these statistics - is it annual or lifetime or something else? Regardless of the timeframe, if that higher risk level is contained almost entirely within the subset of people with small cup to disc ratios then the odds of NAION within this population go up - to somewhere between 0.2% and 3.7% depending on which "at risk" cup to disc ratio and which population study you are looking at. Conversely, it would reduce the risk for everyone else - those with larger than 0.2-0.3 cup to disc ratios - by a factor of 20-33 (1/0.95 to 1/0.97). That's odds of 0.002% - 0.004%. That’s effectively zero. So a lot hangs on whether the effect described in the study changes the odds for people with larger optic nerve cup to disc ratios or it mostly exacerbates the existing predisposition. Seems like figuring that out would be a great service to a large number of people. Of course all of the above is built on a set of assumptions and I am not a doctor or ophthalmologist or medical researcher - so talk to your doctor(s).
How about contrasting the potential unknown issues of the weight loss medications against the **known** issues of chronic long term obesity? It's an absolute no brainier what the winner here is and these medications which absolutely work should be heralded for what they do
That would be the job of a future study, now that this study has properly identified a potential risk.
Within the GLP-1 community most people find they have many more noticeable daily side effects from semaglutide with a smaller payoff. I'd like to see what they find out about tirzepatide. I went with that option because it seemed gentler on the system and more effective.