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Drugs such as Ozempic, Wegovy and Mounjaro (known as semaglutide and tirzepatide) have changed the way clinicians manage diabetes and obesity around the world.

Collectively known as GLP-1 agonists, these drugs mimic the hormone GLP-1. This limits both hunger and interest in food, helping users lose weight, and helps control blood sugar levels.

But two new studies published today show that people taking these drugs may have a small increased risk of serious eye conditions and vision loss.

Here’s what you need to know if you’re taking or considering these medications.

What damage can occur?

Non-arteritic anterior ischaemic optic neuropathy, or NAION, is a rare but devastating eye condition that occurs when blood flow to the optic nerve is suddenly reduced or blocked. It’s also called an “eye stroke”.

The exact cause of NAION remains unclear and there are no current treatments available. People with diabetes are at increased risk of developing NAION.

Unlike other eye conditions that develop gradually, NAION causes a sudden, painless loss of vision. Patients typically notice the condition when they wake up and discover they’ve lost vision in one eye.

Vision tends to worsen over a couple of weeks and slowly stabilises. Recovery of vision is variable, but around 70% of people do not experience improvement in their vision.

What has previous research shown?

A previous study from 2024 found participants prescribed semaglutide for diabetes were four times more likely to develop NAION. For those taking it for weight loss, the risk was almost eight times higher.

In June, the European Medicines Agency concluded NAION represented a “very rare” side effect of semaglutide medications: a one in 10,000 chance. In a first for medicines regulators, the agency now requires product labels to include NAION as a documented risk.

However the recent studies suggest the risks may be lower than we first thought.

In addition to NAION, there is also evidence to suggest GLP-1 drugs can worsen diabetic eye disease, also known as diabetic retinopathy. This occurs when high blood sugar levels damage the small blood vessels in the retina, which can lead to vision loss.

It may sound counter-intuitive, but rapid blood sugar reductions can also destabilise the fragile blood vessels in the retina and lead to bleeding.

What do the new studies say?

Two newly published studies investigated people with type 2 diabetes living in the United States over two years. The studies looked at the medical records of 159,000 to 185,000 people.

One study found semaglutide or tirzepatide was associated with a more modest risk of developing NAION than previously thought. Of 159,000 people with type 2 diabetes who were taking these drugs, 35 people (0.04%) developed NAION, compared with 19 patients (0.02%) in the comparison group.

The researchers also found an increased risk of developing “other optic nerve disorders”. However, it’s unclear what kind of optic nerve disorders this includes, as the medical record codes used didn’t specify.

Counter to this, the second study did not find an increased risk of NAION among those taking GLP-1 drugs.

However, the researchers found a small increase in the number of people developing diabetic retinopathy in those prescribed GLP-1 drugs.

But overall, participants on GLP-1 drugs experienced fewer sight-threatening complications related to their diabetic retinopathy and required less invasive eye treatments compared to the group taking other diabetes medications.

Further studies are still needed to understand how GLP-1 drugs can lead to eye complications. A current, five-year clinical trial is studying the long-term effects of semaglutides and diabetic eye disease in 1,500 people, which should tell us more about the ocular risks in the future.

What does this mean for people taking GLP-1 drugs?

NAION is a serious condition. But we need to strike a balance between these (and other) risks and the benefits of GLP-1 medications in diabetes care, obesity treatment, reducing heart attack risks and extending lives.

The key lies in informed decision-making and identifying different levels of risk.

People with multiple NAION risk factors – such as sleep apnoea, high blood pressure and diabetes – should undergo careful consideration with their treating doctor before starting these medications.

“Crowded” optic nerve heads are also a risk factor for NAION. This is an anatomical feature where blood vessels at the optic nerve head are tightly packed together. People with crowded optic nerve heads should also undergo careful consideration before starting GLP-1 medications.

Although NAION can strike without warning, regular comprehensive eye examinations with your optometrist or ophthalmologist still serve important purposes. They can detect other drug-related eye problems, including worsening diabetic retinopathy, and can identify patients with crowded optic nerve heads. It’s also important to tell them if you are taking GLP-1 medications so they can keep a close watch on your eye health.

Emerging research also suggests that improving your heart health might help reduce risks of developing NAION. This includes proper management of high blood pressure, diabetes and cholesterol – all conditions that compromise the small blood vessels feeding the optic nerve.

Studies also show patients with heart conditions who better adhere to their medication prescriptions have lower risks of NAION than those who don’t.

Doctors should discuss NAION risks during prescribing decisions and work with eye care providers to monitor regularly for diabetic eye disease. Patients need clear instructions to seek immediate medical attention for sudden vision loss and the need for regular eye examinations.

Aggressive treatment of sleep apnoea and other heart conditions may also help reduce NAION risks. But for now, there remains an ongoing need for more research to understand how GLP-1 medications can affect the eye.

LOS ANGELES — Researchers at City of Hope^®, one of the largest and most advanced cancer research and treatment organizations in the United States with its National Medical Center ranked among the nation’s top cancer centers by U.S. News & World Report, today published a new study which found that some survivors of childhood cancer are more at risk for serious health issues as they grow older, including new cancers and chronic conditions like heart disease.

While a cause for concern, the findings published in the Journal of Clinical Oncology also point to a silver lining: The ailments are potentially manageable if caught early and treated.

“Our study underscores the importance of partnership among patients, their primary care providers and cancer survivorship programs to ensure survivors receive necessary screening for the early detection, prevention and treatment of conditions, including secondary cancers, resulting from lifesaving treatment,” said Rusha Bhandari , M.D., a pediatric hematologist-oncologist at City of Hope and corresponding author of the new study. “We at City of Hope are continuing to learn more about what health conditions survivors of childhood cancer are at risk for at different times in their life to inform the updating of evidence-based guidelines for cancer survivors.”

The City of Hope-led study is the first to look at childhood cancer survivors who reached the age of 50, a population that is expected to grow as cancer treatments continue to improve and become more targeted and personalized.

Nearly 15,000 children and adolescents in the United States are diagnosed with leukemia, lymphoma or other types of cancer each year. The rate of young patients surviving cancer for at least five years is now 85%, up from 58% a few decades ago.

To determine long-term risks, Dr. Bhandari, Saro Armenian , D.O., M.P.H., a pediatric hematologist-oncologist at City of Hope Children’s Cancer Center, and their colleagues reviewed a national database that tracks about 40,000 people who were diagnosed with cancer before they turned 21. The researchers identified individuals who were still alive at age 50 and then compared any new incidence of cancer with the rate of cancer found in the general population. The risks for chronic health conditions were compared to the patients’ siblings.

Having overcome cancer at an early age, survivors face new risks when they turn older, the study found. Young patients have a higher risk of secondary cancers and are five times more likely to die from the disease compared to other individuals over the age of 50.

Cancer survivors face increased risks for heart disease as well. In fact, pediatric cancer survivors had a higher incidence of heart problems at age 55 compared to their 70-year-old siblings. They were also more frail, had trouble with physical exertion and suffered poorer health in general.

Looking at the type of cancer treatment survivors had received, the team found that radiation therapy was the main culprit for future risks, rather than chemotherapy.

“Radiation causes cellular DNA damage that can lead to mutations and the development of new cancers,” said Dr. Armenian, senior author of the study.

The study was based on treatment regimens used in the 1970s and 80s. There have been vast improvements since then, including delaying or avoiding radiation in favor of targeted cancer drugs and emerging treatments such as immunotherapy and precision oncology. Still, Dr. Bhandari urges greater vigilance to protect against future health problems.

“Some survivors should screen for conditions like breast or colon cancer at an earlier age than is recommended for the general population,” Dr. Armenian said. “Teamwork is needed to ensure survivors receive necessary screening and preventative care for conditions, including secondary cancers.”

While young cancer patients faced more health problems as they got older, the study did find a bright spot when it came to mental health. Cancer survivors were no more likely to report mental health issues than their siblings at age 50.

“This mental health finding may reflect the resilience and positive mindset of our long-term survivors who have battled cancer,” Dr. Bhandari said. “This is a wonderful example of how our patients continue to inspire us as they navigate their cancer and survivorship journeys.”

A new study supports the first-line role of cervical spine x-ray as a screening exam in blunt pediatric trauma patients. 

The finding is from a 10-year review in which cervical spine (c-spine) x-ray screening had a sensitivity of 100% for clinically significant injuries, noted lead author William Starr, MD, of the University of Utah Health in Salt Lake City, and colleagues. 

“Our study provides a large contemporary cohort where national c-spine protocols are followed showing a normal c-spine [x-ray] and a normal physical examination resulted in zero missed clinically significant injuries,” the group wrote. The study was published August 3 in Trauma Surgery & Acute Care Open. 

Detection of pediatric c-spine injuries and the process by which cervical collars are removed is of the utmost importance, as missed injuries can be devastating, the authors explained. C-spine x-ray has been shown to be a valid screening tool for c-spine injury when coupled with a normal physical examination, and it is recommended by the Pediatric Trauma Society, they added. 

“Despite these recommendations, [x-rays] have been abandoned as a screening tool at some institutions,” the group wrote. 

Furthermore, the sensitivity and negative predictive value of c-spine x-rays have not been evaluated in a large, contemporary cohort of pediatric trauma patients, they noted. 

Thus, the group conducted a retrospective review of cases at their level 1 pediatric trauma center from 2012 to 2021. The hospital’s protocol is to start with x-ray in patients with Glasgow Coma Scale (GCS) scores between 14 and 15 and then go to multidetector CT in patients with a depressed GCS score. The researchers compared a group with negative c-spine x-ray and no additional imaging to a group with negative c-spine x-ray followed by additional c-spine CT and/or MRI. 

According to the results, out of 2,081 patients with negative x-rays, 1,974 (95%) had their c-spines cleared without additional imaging. The remaining 108 patients had additional c-spine imaging after negative c-spine x-ray for c-spine clearance (24 CT, 76 MRI, and 8 both CT and MRI). Indications for additional c-spine imaging were pain (48.1%), a GCS score ≤ 14 (43.5%), and paresthesia (8.3%), the researchers reported. 

“In this cohort, screening [x-ray] had a sensitivity of 100% for clinically significant c-spine injuries,” they wrote. 

Ultimately, although x-ray has been supported as a safe initial c-spine imaging modality for blunt, evaluable pediatric trauma patients, its use remains a complex and debated topic, the authors noted. X-ray has been shown to be more cost-efficient, associated with increased quality of life, and to have a decreased radiation burden when used as the initial screening modality. 

Meanwhile, in adult trauma, the utilization of x-ray has been almost completely replaced by CT, making c-spine x-ray a foreign test in many locations other than pediatric-specific centers, they wrote. 

“As pediatric specialists, it is important that we continue to promote [x-ray] as an important tool in pediatric trauma,” the group concluded. 

The full study is available here.

A study in Israel confirms antibiotic use as a major risk factor for Clostridioides difficile infection (CDI) in hospital patients, particularly for those who don’t carry the bacterium, researchers reported last week in JAMA Network Open.

For the study, which was conducted from June 2017 through June 2023, researchers analyzed data on patients admitted to a large tertiary medical center in Israel that routinely screens high-risk patients for C difficile carriage. While broad-spectrum antibiotic use is a known risk factor for CDI, the researchers wanted to evaluate the rate of hospital-onset CDI among asymptomatic C difficile carriers compared with noncarriers and assess the role of antibiotic exposure in shaping CDI risk in the two populations.

Antibiotic exposure linked to double the risk of CDI

Among 33,756 hospitalizations (median age, 78 years; 52.8% male), 1,624 (4.8%) had a positive screening result for C difficile. Overall, CDI occurred in 67 (4.1%) of 1,624 carriers and 47 (0.1%) of 32,132 noncarriers. 

In the entire cohort, exposure to any antibiotic was associated with double the risk for CDI (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.24 to 3.16), with each additional day of antibiotic exposure having an HR of 1.08 (95% CI, 1.03 to 1.13). Beta-lactam/beta-lactamase inhibitor combinations were associated with significantly increased risk, with piperacillin-tazobactam showing the most pronounced hazard for CDI (HR, 2.18; 95% CI, 1.41 to 3.36).

Although a positive C difficile screening result at admission was associated with a high risk of CDI (HR, 27.5; 95% CI, 18.7 to 40.3), antibiotic exposure among asymptomatic C difficile carriers was not significantly associated with a further increase in CDI risk (HR, 1.07; 95% CI, 0.73 to 1.58).

The study authors say the findings suggest that, while antibiotic stewardship may reduce CDI risk in noncarriers, additional strategies may be needed for asymptomatic carriers.

“Among carriers, preventive measures in addition to antibiotic stewardship should be evaluated in hospitalized patients and may include probiotics, monoclonal antibodies, or biotherapies,” they wrote. “However, further research is necessary to evaluate the potential effectiveness of these interventions, their association with microbiome alterations, and potential changes in antimicrobial resistance patterns among patients and within the hospital environment.”