Ozempic makes you twice as likely to develop this debilitating condition — what that really means for your risk
Now a new study is bringing into focus the relationship between diabetic GLP-1 users and the elevated risk of age-related eye disease.
But despite seemingly alarming numbers, a doctor explained to The Post why she doesn't actually think it should steer people away from the jab.
3 A 2024 study found that 12% of the US population has taken a GLP-1 drug at some point, with around 6% currently using them.
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Published in JAMA Ophthalmology, the study was drawn from the health records of nearly 140,000 patients.
Researchers found that after one year, GLP-1 users were more than twice as likely to develop neovascular age-related macular degeneration than those who were not taking the drugs.
Age-related macular degeneration (AMD) is a disease that gradually damages the macula, the part of your eye's retina responsible for sharp, central vision. As it worsens, people find it increasingly difficult to see things directly in front of them, while their peripheral vision remains largely unaffected.
In older people, AMD is a leading cause of irreversible blindness.
The study found the risk percentage was 0.2% in GLP-1 users and 0.1% in nonusers.
Nearly 20 million adults in the US are living with AMD, which comes in two types.
The slower-moving dry AMD makes up about 80% of cases. It occurs when the macula gets thinner with age, often due to the buildup of yellow protein deposits known as drusen, according to the American Academy of Ophthalmology.
Wet AMD, also known as neovascular AMD (nAMD), while less common, is far more aggressive, causing rapid and severe vision loss. In this form, the macula's function is compromised by the growth and leakage of abnormal blood vessels beneath the retina. The condition is typically treated with frequent injections to restore or stabilize vision.
3 Kaden notes that while there is cause for concern, headlines will amplify what she believes is a relatively low risk
Northwell Foundation
'What researchers in this latest study were looking for specifically was whether or not these were people who converted from the dry form of macular degeneration, which is where you don't have abnormal blood vessels to the wet form, which is when you do,' Dr. Talia Kaden, director of the Northwell Health retina fellowship told the Post.
But Kaden noted that while there is cause for concern, she actually believes there a relatively low risk.
'We're talking about a handful of patients who might have an increase in retinopathy compared to the millions of patients on these medications.' Dr. Talia Kaden
'That 2X number is really powerful, but when you look at the raw data, I don't think it's quite as strong a punch. I don't think that number should be a reason for people not to be on these drugs. I do think, though, it is worth continuing to look into,' she said.
This study adds to a growing body of research documenting vision problems in patients using GLP-1 drugs.
A review published earlier this year in JAMA Ophthalmology uncovered at least nine cases of patients who experienced vision loss after taking semaglutide or tirzepatide, the active ingredients in Wegovy and Zepbound, respectively.
And a 2024 study suggested a potential link between semaglutide and the rare eye condition nonarteritic anterior ischemic optic neuropathy (NAION), in which restricted blood flow to the optic nerve causes sudden-onset vision loss.
'None of these studies are definitive in identifying that there has been a change. Some of them show a slight increase, but we're talking about a handful of patients who might have an increase in retinopathy compared to the millions of patients on these medications,' Kaden said.
3 In older people, AMD is a leading cause of irreversible blindness.
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Researchers think that declining blood glucose levels caused by GLP-1s could trigger abnormal blood vessel growth in the retina. Further, there are GLP-1 receptors in the retina, and these drugs increase the levels of molecules that lead to harmful blood vessel formation.
'Seeing such a clear signal in our study was striking,' co-author Reut Shor of the University of Toronto told STAT.
'The absolute risk remains low, but the advanced form of AMD is a condition with serious implications for vision and quality of life. So a doubling of risk is clinically meaningful, particularly for vulnerable populations like older adults who may already be at elevated baseline risk.'
Shor and his team note that more research is necessary to determine whether direct or indirect effects are causing the increased risk of nAMD.
Shor and Kaden maintain that these findings should not be cause for alarm nor a reason to halt the prescription or use of these medications; rather, patients should be made aware of the risk and monitor their vision accordingly.
Kaden, the study authors, and other experts recommend that GLP-1 users be on the lookout for any vision changes that could indicate early signs of AMD.
'We really want you to look for anything blurring, any new distortion. If you're looking at a flagpole or a doorframe, that should be a straight line. If all of a sudden that line looks wavy or curvy, that's a reason to seek a consultation with a retina specialist,' said Kaden.
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Vox
44 minutes ago
- Vox
The one, big unanswered question about Ozempic
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. We are nearing a point of no return for GLP-1 drugs. More than one in 10 Americans have already taken a GLP-1 agonist, be it Ozempic, Wegovy or Mounjaro. The medications, originally developed for diabetes treatment, have proven to be remarkably effective in helping people lose weight — and America is in the throes of an obesity crisis. They have shown promise in treating cardiovascular diseases, the country's leading killer and a direct consequence of the obesity epidemic. With each additional study finding yet another application for these drugs, you might find yourself asking: Should I be taking Ozempic? Should everybody take it? Is there anything these drugs can't do? And indeed, right now it can seem like everyone will be taking GLP-1, sooner or later. These drugs currently require regular injections and can cost more than $1,000 out of pocket, but cheaper and more easily used versions are coming. Eli Lilly will soon bring a pill version to the market, with a version expected to debut at a lower price than injectable Ozempic or Wegovy did. A generic GLP-1 agonist is on track to arrive at Canadian pharmacies in 2026 and a US version will likely follow within the next decade. Some of the newer versions in development may prove to be even more effective than the first generation, which will only create more demand among doctors and patients. Put it all together, and we can expect many, many more people taking them. GLP-1 drug prescriptions for adults with commercial insurance increased by a staggering 364 percent from 2019 to 2024, but they were still only prescribed to 4 percent of insured US adults; more than 100 million US adults — 40 percent of the population — are obese, the Wall Street Journal reported earlier this year, and as more insurers cover these drugs for weight loss, more patients will be able to access them. These drugs' power comes from their mysterious ability to control people's compulsions. Patients who take an GLP-1 agonist say that the fatty ultraprocessed foods they used to find irresistible are no longer so tempting, though sometimes those old cravings for unhealthy junk come rushing back after taking the drugs for a while. Substances as habit-forming as coffee no longer hold the same sway. Others notice decreased desires that have nothing to do with their diet — to bite their nails, for example. We are entering the Ozempic era, and even as excitement grows about the possibilities for these medications, now is the time to take seriously the possible risks from this new class of drugs. A lot of people experience brand-new cravings, sometimes for healthier foods. 'Beans — I get cravings for beans. I never really ate them before, now I crave homemade baked beans in a tomato sauce,' Sarah, a charity development worker from Scotland who has been taking a GLP-1 compound for a few months, told me by email. 'It used to bother me if a cafe served beans on a cooked breakfast; now beans is the main part of my breakfast.' Swapping salad greens for carbs sound like a clear win — in fact, it sounds almost too good to be true. In the long term, what does it mean to modulate our desire? Are we sure we can suppress the harmful compulsion to eat too much without compromising the productive ones — such as the desire to succeed or the pleasure we find in personal relationships? How might these drugs impact our experience of joy and pain? What might that do to impact the messy human experience of…simply living? 'What are the very long-term effects of these drugs? The literature will say, 'Well, there isn't really bad long-term effects because some people have been taking it for diabetes for 10 years, and they don't have bad effects,'' Kent Berridge, a professor of psychology and neuroscience at the University of Michigan, told me. 'And I think that's a fair argument. But then 10 years is not 20 years or 30 years.' We are entering the Ozempic era, and even as excitement grows about the possibilities for these medications, now is the time to take seriously the possible risks from this new class of drugs. In my conversations with some of the top experts on the science of cravings, they offered a cautious outlook in regard to messing with our brain's desire pathways. But they were also optimistic that these drugs could deliver benefits to many Americans without turning us into emotionless robots. Why GLP-1s work for so many different medical conditions In the 1980s, scientists had identified the naturally occurring hormone GLP-1 and its importance in regulating people's digestion. By the end of the decade, investigators had confirmed that the hormone encouraged insulin production — offering the potential to treat people with diabetes, who struggle to produce insulin that regulates their blood sugar. Then just a few years later, a scientist identified a peptide from the Gila monster that was similar to the human hormone GLP-1 but came in a more stable form, offering therapeutic potential. By the mid-2000s, the first GLP-1 agonist drugs were approved for diabetes, but the daily injections required and the narrow focus kept the market small. In 2017, the Food and Drug Administration approved Ozempic — a weekly injection, rather than a daily shot. By that point, doctors had already begun to notice that some patients who took the GLP-1 agonists experienced a reduced appetite with resulting weight loss. Researchers began to study the weight-loss effects and they were stunned: One of the first studies found users lost 15 percent of their body weight, on average, in little more than a year, a wildly larger percentage than from any other weight loss drug or tool. The Ozempic fervor had begun. Specialty pharmacies started to sell off-brand compounded versions of the drugs. The FDA then approved Wegovy, an Ozempic successor, for weight loss in 2021, and in 2023, Zepbound got the green light for weight-loss prescriptions. As their astonishing weight-loss effects became clear, research into GLP-1 agonists and their health benefits exploded. Today, the list of possible benefits is genuinely astounding. But how, exactly, do they work? First, a drug like Ozempic mimics the natural GLP-1 hormone in your gut, which slows down digestion in the stomach and gastrointestinal tract. Those who take it feel fuller earlier and longer, and it's easier for them to eat less. The better regulation of blood sugar also prevents massive swings in glucose, which can induce hunger. As a result of its effect on digestion, the most common clinical side effects reported with Ozempic and its peers are nausea, vomiting, diarrhea and constipation. In clinical trials for GLP-1 treatment for diabetes or obesity, between 4 and 12 percent of patients experienced constipation; a similar share of patients endured vomiting and diarrhea. There have been reports of other rare but serious physical side effects: The drugs have been linked to an elevated risk of eye disease among older patients, for example. Some people who lose weight quickly experience temporary hair loss, a symptom that a small number of patients on GLP-1 medications have anecdotally reported. But scientists have also discovered these drugs can affect your brain directly, with sometimes surprising and unpredictable effects on people's cravings — for food and for other things. Naturally occurring GLP-1 secretes from in a person's intestines into their blood and it disappears within a matter of minutes, destroyed by enzymes in the blood, Berridge said. As a result, it does not cross into people's brains very easily. The drug form, GLP-1 agonists, on the other hand, can cross this barrier. When a person takes Ozempic or Wegovey or whichever GLP-1 they've been prescribed, the semaglutide endures for a long time, giving it more time to cross into the brain. Once the chemical is in that person's brain, it can turbocharge neurons in your brainstem that naturally produce some very small amounts of GLP-1. Those neurons then release the hormone into many other parts of the brain and disrupt the release of dopamine, which produces that little surge of pleasure that makes eating a sweet sugary piece of cake so damn good or finishing a half marathon after months of training so satisfying. 'The drugs are getting into these structures and it turns out that they suppress cravings in all of these places, including the reward-system ones,' Berridge said. Scientists began to make this connection when observational studies reported that people who took a GLP-1 agonist for its diabetes or weight-loss effects also reported consuming less alcohol or fewer illicit drugs than they did before. Researchers started to probe further, experimenting with injecting microdoses of a semaglutide directly into the brains of animals in lab studies, and they have found a decrease in all kinds of cravings, including powerful compulsions for cocaine and heroin. These findings have introduced the startling possibility that, beyond food, we could control some of the most uncontrollable urges that people struggle with, often to the detriment of their health. But they also bring us to the big question: If we can turn down the volume of our desire, how might that change the very emotions that make us human, the experience of our deepest joys and pleasures? What the science on desire can tell us about GLP-1s I've started to think of the dilemma these drugs present this way: Can I cut off the part of my brain that compels me to reach for a bag of potato chips at night, without compromising the desire to sit down and read books with my children? Unfortunately, we simply don't know yet. Scientists aren't exactly sure how these complex human desires interact. The desire to eat, for example, is one of our oldest evolutionary impulses, Berridge, the Michigan neuroscientist, told me. Can we really mess with that ancient part of our brain without unintended consequences? There are at least two ways of thinking about what the answer might be. First, the (maybe) good news: Berridge's research has focused on the distinction between wanting something and liking it. He told me if Ozempic can eliminate our unchecked wanting of something that's bad for us — such as fatty, processed foods or alcohol, for example — but still maintain our enjoyment of it, that would suggest people who take it are not suddenly at risk of losing all of the pleasure in their lives, including other things that also cause a surge of dopamine in our brains, like finishing a creative writing project after months of work or cherishing conversations with your friends. This is a concept that my former colleague Brian Resnick explored last year: GLP-1s have the ability to manipulate a figurative 'dial of desire' in our brains, which could be leveraged for good. In the 1980s, Berridge worked on a series of experiments with a colleague, Terry Robinson, in which they eliminated dopamine in rats. What they observed was the rats stopped voluntarily eating, drinking, and seeking other rewards set up by the investigators. However, when they were given something sweet to eat, their faces would react positively to the taste, just as they normally would. That reactivity, the researchers postured, was a proxy for their joy. The rats could also still become averse to new sensations, which again affirmed a capacity for strong emotions, even if their compulsiveness had been removed. Berridge told me he actually doubted their findings at first — how could you like something but not want it? — but it continued to be replicated in experiments by other investigators over the years. In one particularly revealing experiment from 2005, participants were given cocaine and a dopamine-blocking drug. They still liked the cocaine when they were given it, but their desire for additional cocaine was dampened when the dopamine was blocked. The study was small, but it affirmed Berridge and Robinson's initial insight: Dopamine appears to influence the wanting of things, rather than the liking of them. Early studies of Ozempic patients indicate most participants still enjoy their food despite their compulsion to eat being reduced. Some of them, including some of the patients I spoke with, also found themselves desiring healthier foods. 'That's encouraging,' Berridge told me. 'I would say that's a good thing.' However, another way of understanding desire would raise more cause for concern. Jackie Andrade, a psychology professor at the University of Plymouth, has worked with colleagues on the Elaborated Intrusion Theory, which proposes that all our cravings are not unique brain processes but part of our general motivation. According to this theory, when we encounter certain 'triggers' — such as a physical sensation or some environmental cue — the trigger leads to a burst of spontaneous thoughts about an object of our desires. And when we begin mentally picturing our desire, our craving for it only increases. Here is the key finding, Andrade told me: The object of desire — whether it be alcohol, chocolate, or cigarettes — is less important than the underlying mental processes involved in craving. The brain mechanisms are the same regardless of the craving, based on their observations of people's brain patterns when being presented with different triggers. We crave something because the image of it in our minds is briefly pleasurable and thinking about whatever it is boosts our mood, which in turn strengthens the craving and our awareness that we don't have it. This explains one of the conundrums about desire: Our desires are thoughts and thoughts require mental effort. So why aren't they easier to shake? This cycle of environmental triggers — seeing a billboard advertising fast food or attending a cookout with chips and dip on display — leads to our imagining the craving, which leads to both pleasure if we satisfy it and frustration if we don't, which is why we feel such strong impulses to resolve the cravings. But, at least according to the Plymouth researchers' work, there is not a clear distinction between a craving for a piece of pizza and a craving for something more productive. 'From our research, the cognitive processes are the same for both,' Andrade said. 'Could we have less driven entrepreneurs or marathon runners because they're on these drugs and they're too chilled out to want to do anything? Right now, we don't know.' What we still need to figure out about these drugs Even as their usage explodes, the reality behind these drugs and how they affect our desires is still a mystery. Pills are likely to have the same effect as injections on cravings, Berridge told me, so long as the GLP-1 agonist is still crossing into people's brains. 'In what sense is it reducing wanting? Because there's a couple of possible ways. One way would be to subtract a degree of intensity from every want,' Berridge said. 'So addictive wants go down, but then so do the everyday desires in life and even eagerness to go out into the world and face it and do things. That would be bad if it was a general subtraction in intensity of wanting.' 'On the other hand, it is possible that that's not what it's doing, but rather it's lowering the ceiling,' he continued. 'So really intense peaks of wanting can't go so high, but things below that ceiling can still remain normal.' In other words, GLP-1 agonists can only decrease the intense peaks of our cravings, which could allow us to, for example, not binge-eat or overdrink — without eliminating a more normal intensity of wanting for other things. The problem is, Berridge said: 'I don't know of any actual studies that have asked this question.' He said he would like to see a study that measures people's motivation to pursue a wide range of incentives, both mild and intense ones, when on and off one of these drugs. Researchers at the University of Plymouth are setting up studies that would evaluate behavioral changes in people who take the GLP-1 medications. We need more evidence, because what we have right now is circumstantial and inconclusive anecdotes. Peruse the many Reddit communities devoted to these weight-loss drugs and you'll see the subject of cravings come up a lot. Some people describe food cravings that come back after a few months of taking Ozempic or Wegovy. Others report strange new cravings they never experienced before, such as a sudden taste for milk. Some of the changes are expected — decreased desire for nicotine or alcohol — but some are puzzling: One user, a true crime aficionado, described a reduced desire to look at dark or gory materials online after being on a GLP-1 agonist. Others responded by sharing that they were less compelled to shop online or stopped biting their nails. Sarah, the charity development worker from Scotland, told me she started taking a GLP-1 drug three months ago after she gained weight during perimenopause and was struggling to lose it. She's since lost 18 pounds. There have been some physical side effects — fatigue and acid reflux — and she's noticed a significant shift in her cravings. Whereas she used to mix salads with pasta, she finds she no longer craves the carbs. Mashed potatoes used to be one of her favorite foods, but she hasn't eaten that once since going on the medication. At the same time, she has new hankerings for beans and green apples — which she told me she found puzzling because she says she used to hate the sound of teeth crunching into an apple. 'I don't get the same emotions from food,' she told me over email. 'It's nice, I enjoy it, but I don't feel food in the same way.' She, like many other patients, also says she no longer experiences the same desire to drink alcohol. She told me she drinks at most one night on the weekend and no longer attends happy hours with her colleagues like she used to, when she would have a few drinks midweek. 'I don't go and not drink, I just don't go,' she told me. 'Drunk people are tedious when you're sober!' GLP-1s are genuinely promising, but they also reveal our insatiable desire to find a wonder drug that takes care of all of our problems in one pill. Andrade said we should resist that temptation, even if Ozempic and its peers could play a role in helping to address important health crises. Research has consistently found that weight loss tends to be more sustainable when it includes behavioral changes in addition to pharmaceutical interventions. Ideally, you would do both: work on modifying your behavior, while medication assists. Losing weight isn't just about eating less, but eating healthier and exercising more in order to enjoy the health benefits that those positive activities produce. If Ozempic affects all kinds of motivation, patients may not be as driven to adopt those other desirable behaviors. 'If people are taking these drugs, are they more motivated to, say, become more physically active or to eat more healthily? Or are they less motivated because the drugs are doing it for them?' Andrade said. 'There's the risk that people might not want to make changes. If you've still got a bad diet and a sedentary lifestyle, you're building up other problems that are maybe a little bit more hidden because the obesity is not there.' This is already an ongoing subject of concern: Some studies have suggested that people who stop taking Ozempic gain back much of the weight they lost; that may be because they are not adopting desirable new behaviors — better eating, more activity — alongside their taking the drug. On the flip side, some doctors say they also worry about people who take the drugs for reasons other than weight loss but end up undereating and increasing the related health risks of undernourishment. Are these findings a canary in the coal mine for other unexpected and undesirable side effects related to the drug's effects on cravings? It's a genuinely vexing question. After all, many people take these drugs because they do have a problematic compulsive behavior — they eat too much. Getting those cravings under control is the point of getting a prescription. But are people also losing other less obvious desires? Are they losing, in a sense, a part of themselves? The evidence for now is mixed. One Reddit user joked they felt like they were getting mental health care they didn't know they needed. Two Reddit users shared that they had cut down from multiple cups of coffee in the morning to one (or less). 'I'm kind of bummed about it,' one said. 'I love my coffee.' 'Same. I love coffee,' the other poster replied.
Vox
44 minutes ago
- Vox
Welcome to the August issue of The Highlight
It sometimes seems like Ozempic (and its ilk) is a miracle treatment, not just for weight loss but for all manner of other conditions and cravings. As GLP-1 drugs grow in popularity, and with the prospect of Ozempic pills on the horizon, it's time to ask: What's the catch? Also in this issue, you'll find a feature on the terrifying consequences of America's protein craze and an analysis of the testosterone theory of politics. Plus: Whatever happened to the friend setup? And how to make the hardest choices of your life. By Dylan Scott By Sigal Samuel The testosterone theory of politics By Leo Kim Coming July 29 Most couples used to meet this way. What happened? By Allie Volpe Coming July 30 The terrifying reality behind one of America's fastest-growing dairy brands By Kenny Torrella Coming July 31 The one-sided intimacy of being a fan By Aja Romano Coming August 1
Axios
an hour ago
- Axios
Why GLP-1s could become the "everything drug"
The biggest buzz around GLP-1 drugs these days has nothing to do with weight loss. And that might lead to some problems for patients and insurers. The big picture: Blockbuster treatments like Ozempic have been found to lower the risk of everything from Alzheimer's and addiction, to sleep apnea, seizures and bacterial infections. More potential uses keep surfacing. While it may be tempting to think of them as wonder drugs, there's a lot that's still unknown. It's still not clear whether they're a cure-all, or whether the benefits come from the fact that obesity and diabetes give rise to so many other health problems. At over $1,000 a month, GLP-1s are also driving up costs in the health system, and their benefits can go away if patients discontinue the medications. State of play: The injectable drugs' potential beyond weight loss was driven home early this year by a study of almost 2 million Veterans Health Administration patient records that found GLP-1s lowered the likelihood of dozens of health conditions. Researchers found the benefits were modest — about a 10% to 20% reduction in most cases — but noted that could be meaningful, especially for conditions like dementia that have few effective treatments. "Given the drugs' newness and skyrocketing popularity, it is important to systematically examine their effects on all body systems — leaving no stone unturned — to understand what they do and what they don't do," Ziyad Al-Aly, the study's senior author said. Friction point: The Food and Drug Administration has only approved GLP-1s for obesity, Type 2 diabetes, heart risk and, under certain circumstances, sleep apnea. That means using them for any other condition is "off label" and at a physician's discretion. The designation can affect whether insurers pay for the treatments. That's no small matter when the monthly cost of brand-name options like Wegovy and Zepbound range from $1,000 to $1,350 without coverage. The hype around the drugs has sent many Americans to telemedicine companies that sell brand-name or knockoff GLP-1s. One recent study found that nearly 40% of GLP-1s approved by the FDA for diabetes are being prescribed off-label. Meanwhile, drug supply shortages and patchwork health plan coverage policies have made GLP-1s less available to patients most in need, including those in marginalized communities. Dozens of lawmakers in Congress last week pressed the FDA to take action against illegal, counterfeit versions of the active ingredients in Ozempic and Wegovy. Reality check: While the drugs have enormous promise, they come with significant side effects, including increased risk for gastrointestinal disorders, low blood pressure, kidney stones and pancreatitis. Surprisingly for weight-loss treatments, there can be a higher risk for arthritis, possibly due to loss of muscle and bone mass. More than 36% of patients who start GLP-1s for either obesity or diabetes treatment stop taking the drugs within a year, according to one study. The cost and adverse effects are often cited as reasons. And although GLP-1s could lower future health costs by preventing more health problems, expanding Medicare coverage of the drugs could drive up federal spending by $48 billion over the next decade. The pricey drugs are already contributing to increasing premiums for employer-sponsored health insurance. The intrigue: The action of GLP-1s could tell us more about how the brain works, by the way they appear to tamp down inflammation and protect nerve cells. They also control cravings and feelings of satisfaction — qualities that could make them important tools for treating substance abuse, suicidal thoughts and even schizophrenia. So, should we all be taking them? The consensus among many clinicians and researchers is "no," or at least not until more is known about how they work. "While I'm excited about the future of these drugs' development, the side effect profile isn't worth the risk for otherwise healthy patients," author-journalist Derek Thompson wrote recently in a Substack review of recent developments and interviews with researchers. What we're watching: Drug companies are moving to develop GLP-1s in pill form, which would make them easier to take and potentially keep people from cycling on and off as much.
