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Good analysis, doctor. It would help if we had a better understanding of NAION. I agree that its onset more often in the first year is more likely due to the presence of other risk factors than the GLP -1- agonists. When 3rd tier specialists discover an apparent correlation that they believe needs more study, I wish journalists would be more circumspect about publishing the correlation in the lay press. This is especially a problem with something people fear as much as vision loss.

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This is so well stated, and the line of communication from highly specialized third tier specialist worlds right into the lay press and then to the average reader really drives anxiety and clicks. I hope there is not a causation mechanism here, and with 25+ more GLP-type medications in the pipeline (!!) there are ongoing RCT's to see if this is a class effect. Probably researchers are looking into semaglutide again... I don't think NAION has ever shown up on the other GLP trials that were prospective, placebo controlled. I share your dread of vision loss and other problems as our eyes age at varying speeds and to different degrees!

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Great minds (or just crazy LOL)? My next post tomorrow will have a fair bit on GLP-1 as well. Seems you cannot read more than a few journal pieces before stumbling on this subject. Glad you are taking the time for Px to understand the effect of the drug and are keeping you informed on medication plus any herbal/vitamin supplement (natural or not).

Also appreciate the note about diabetic vision problems as well. Why we have screening for this.

Great job and pretty nice dive.

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Thanks KB, I'll look forward to your post tomorrow! I've been putting off a GLP post because of the very ubiquity of chatter and news about them constantly. The topic is really hard to stay focused on as the effects sprawl into so many body systems and conditions and mechanisms. I literally had two different people ask me about the "vision problems" associated with Ozempic yesterday, and so to answer their questions I wanted to make sure I did a deeper dive than the 20 minutes allow in the office... hence the adaptation into a post. Talk soon ;)

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Sep 5Liked by Ryan McCormick, M.D.

Appreciating you

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I admit this caught my eye over the summer (sorry) and I deferred worrying about it too much because we are constantly bombarded with the disclaimers and possible this and that on the advertisements of all medications, which all carry risks. Good to research this! And you must get some many questions all day long from the "talk to your doctor" about everything phrase like this article I googled just now for more information (your's was much deeper):

https://www.eyephysiciansoflongbeach.com/uncategorized/understanding-the-association-between-ozempic-and-naion-what-patients-need-to-know/

"Given the current evidence, patients taking Ozempic or Wegovy should not be alarmed but should remain informed. Dr. Shauna Levy, an obesity medicine specialist, mentions that the findings will not change her prescribing practices, as the overall risk remains low. However, patients who have existing visual loss or are concerned about their risk of developing NAION should discuss these findings with their healthcare provider. It’s crucial to weigh the benefits of semaglutide in managing diabetes and weight loss against the potential risks.

In summary, while the association between semaglutide and NAION warrants further investigation, patients should consult their doctors to make informed decisions about their treatment options. Ongoing research will help clarify the relationship and ensure patient safety."

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Sep 5·edited Sep 5Author

Hi Grant - I agree again with you that list of "talk to your doctor about" keeps getting absurdly long! This is a good quote you shared and the article seems to mirror my own in its conclusions, so that is always good to know. The part about people with existing vision loss or heightened concerns being more likely to proceed with caution sounds right... the exact situation and conversation I had yesterday with a patient actually.

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Sep 6Liked by Ryan McCormick, M.D.

If one listens to or reads the hazardous side effects notifications, only the reckless would risk taking these drugs! People tend to ignore the fine print on anything it would seem. We trust our prescribing physicians to sort it all out for us. That puts a very heavy load on you doctors I would guess.

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I had this experience this summer with acetazolamide, for altitude sickness. Very glad I took it at 13,000 feet in Colorado as I would’ve been really sick otherwise, but if you look at the actual potential side effects, it’s pretty paralyzing!

Serious Reactions

Metabolic acidosis

Electrolyte imbalance

Anaphylaxis

Erythema multiforme

Stevens-Johnson syndrome

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Common Reactions

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Melena

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THANKS for bringing this up. But I was taken aback on their figures for cumulative incidence. NIH StatPearls puts incidence of NAION at 2- 6 /100K/yr in general population. Not clear if that is over 50yo. But suppose it is not. Over 50 is about 1/3 of the population. So then the incidence is 2-6 /33K. Or taking the high and rounding for ease of numbers, 2 per 10K. While the T2DM population is different than the general population, it’s not THAT different. The population attending a tertiary care NeuroOphth clinic is …. Well I do not know how it compares to the general population. But wow it must be different if they have BASELINE incidence over 36 months of 1 -2 % . Seems high . Wonder why they only recruited from the NeuroOphthal clinic , why not the Mass System at large ??

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Such good points Michael thank you! I also took a double take at the baseline incidence in the non-intervention group. NAION is not something I see in primary care much if at all, so this kind of RR and AR % really need to be emphasized as occurring within a very subspecialized population. I spent a lot of time reading the confounders for sure. Thanks for your close read here. Going to come back to your comment again.

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