- Introduction:  

  - JAMA Ophthalmology Author Interviews feature discussions with authors about the latest clinical research, reviews, and opinions in JAMA Ophthalmology.  

  - Host: Neil Bressler, Editor-in-Chief of JAMA Ophthalmology.  

  - Guest: Dr. Bradley Katz, Professor at the University of Utah Health, discussing ophthalmic complications linked to anti-diabetic drugs semaglutide and terzepotide.

- Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION):  

  - Described as an "optic nerve stroke," typically occurring in patients aged 50s-60s.  

  - Associated with nocturnal hypotension and vascular risk factors like hypertension, high cholesterol, diabetes, and smoking.  

  - Usually painless, noticed upon waking, and affects one eye.  

  - Optic nerve swelling resolves in about six weeks, with potential peripheral vision loss.

- Risk Factors:  

  - Small cup-to-disc ratio (0.1-0.3) is a significant anatomical risk factor, leading to optic nerve crowding and compromised blood flow.

- Study Background:  

  - Semaglutide and terzepotide, GLP-1 receptor agonists, are increasingly used for glycemic control and weight loss.  

  - A 2024 JAMA Ophthalmology article reported an increased risk of NAION with semaglutide.  

  - Dr. Katz’s investigation began after observing a patient with sudden vision loss after semaglutide use.

- Case Collection:  

  - Dr. Katz collected 8 cases (6 NAION, 1 papillitis, 1 paracentral acute middle maculopathy) linked to semaglutide or terzepotide.  

  - Onset of NAION ranged from 1 day to 16 months after starting the drug.  

  - Some cases showed bilateral disc swelling, atypical for NAION.

- Survey Limitations:  

  - Survey sent to 800+ neuro-ophthalmologists; only 4 reported similar cases.  

  - Lack of scientific rigor due to retrospective recall and potential underreporting.

- Hypotheses for Association:  

  - Rapid glycemic control with semaglutide may exacerbate diabetic retinopathy or induce optic nerve swelling (papillitis).  

  - In patients with a small cup-to-disc ratio, swelling could reduce blood flow, leading to ischemic events.  

  - No definitive proof of causation; association may be coincidental.

- Recommendations:  

  - American Academy of Ophthalmology recommends further post-marketing surveillance to determine NAION prevalence.  

  - Physicians should introduce semaglutide slowly to avoid rapid glycemic changes, potentially reducing NAION risk.  

  - Diabetic patients should undergo regular retinal and optic nerve exams.

- Patient Outcomes:  

  - 6 out of 7 reported patients were diabetic; 1 used semaglutide for weight loss.  

  - Most retained vision in the unaffected eye, but none experienced visual recovery in the affected eye.  

  - One patient became functionally blind, impacting daily life significantly.

- Conclusion:  

  - Dr. Katz emphasizes the importance of monitoring diabetic patients on semaglutide for both retinopathy and optic neuropathy.  

  - Further research is needed to understand the relationship between semaglutide and NAION.  

  - The study highlights the need for cautious use of these effective but potentially risky drugs.