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Diabetes is a chronic disease that affects the lives of millions globally. Along with elevated blood sugar levels, diabetes brings an increased risk of various complications if left uncontrolled. One such complication that can threaten vision is diabetic retinopathy.
Recent studies suggest that about 27% of diabetic patients may develop retinopathy. This retinal damage stems from the effects of prolonged high blood glucose on the eye's delicate blood vessels and nerves.
As an ophthalmologic condition, diabetic retinopathy warrants proper medical care and lifestyle adjustments for optimal management. One key aspect of diabetic retinopathy care is maintaining healthy blood sugar levels.
For those with type 2 diabetes, medications like semaglutide may assist with glycemic control and weight loss. But what implications could these medications have on diabetic eye disease?
To help unravel the facts around semaglutide and diabetic retinopathy, we reviewed key scientific findings and insights from retina specialists. Read on for an evidence-based look at how semaglutide could impact the progression and treatment of this vision-threatening diabetes complication.
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Diabetic retinopathy occurs when high blood sugar levels from uncontrolled diabetes damage the blood vessels supplying the retina. The retina is the innermost, light-sensitive layer of the eye responsible for central and color vision.
In the early stages, called nonproliferative diabetic retinopathy, the walls of retina's tiny blood vessels weaken and develop microaneurysms that leak fluid. Small blockages may also occur, depriving retinal tissue of blood supply. People often have no symptoms during these initial changes.
Without treatment, nonproliferative retinopathy can advance to a more serious proliferative stage. Aberrant blood vessels proliferate along the retinal surface. These abnormal vessels are prone to hemorrhage, scarring the retina and clouding vision. Fluid buildup in the eye's interior can also cause retinal detachment.
Diabetic retinopathy poses the threat of irreversible blindness if not managed properly. That’s why optimal blood sugar control and routine eye exams are vital for prevention.
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Proliferative diabetic retinopathy represents an advanced stage of diabetic eye disease with visible retinal bleeding and abnormal blood vessel growth along the retina’s surface.
Several key factors drive this proliferative progression:
| Cause | Description |
| Impaired Oxygen Delivery | As more retinal capillaries become blocked and damaged, oxygen supply to the retina declines. Low oxygen triggers the release of growth factors that promote new blood vessel proliferation. |
| Fragile New Blood Vessels | The new blood vessels that sprout along the retina are structurally weak. They're prone to bleeding into the vitreous cavity, the jelly-like substance filling the eye interior between the lens and retina. |
| Traction on the Retina | As fibrous scar tissue forms, it can tug on the retina, distorting its normal shape and alignment. This traction raises the risk of retinal tears and detachment. |
| Fluid Buildup | Damaged retinal vessels become permeable, often leaking fluid into the macula, the central part of the retina used for sharp vision. Fluid distorting the macula’s shape contributes to central vision loss. |
Proliferative retinopathy requires treatment to seal off abnormal vessels, prevent bleeding, and reduce scar tissue formation. Otherwise, permanent vision loss can occur.
Diabetes can cause a number of changes in the eyes that can lead to diabetic retinopathy. Here is a more in-depth look at how high blood sugar levels damage the eyes:
High blood sugar levels (hyperglycemia) from uncontrolled diabetes can cause damage to blood vessels throughout the body, including the tiny capillaries that supply oxygen and nutrients to the retina. The high glucose levels thicken the walls of the retinal capillaries, making them narrower and less able to adequately transport blood.
These weakened retinal blood vessels have trouble maintaining normal blood flow to the retinal tissue. Reduced blood flow deprives the retina of oxygen and nutrients, causing the retinal tissue to become damaged.
Uncontrolled diabetes reduces the functioning of nerves in the retina that control the constriction and dilation of blood vessels. Nerve signals that trigger the retinal blood vessels to expand and contract become impaired.
This affects the retina's ability to properly regulate blood flow based on oxygen and nutrient needs. The fluctuation in blood flow further stresses the already weakened retinal blood vessels.
Large swings in blood glucose levels, known as glycemic variability, places additional stress on retinal blood vessels over time. The constant stretching and shrinking of blood vessels from glucose fluctuations can weaken the vessel walls, making them more prone to leaking and hemorrhaging. Keeping blood sugar levels stable through medication, diet, and exercise helps minimize this vessel damage.
Elevated blood glucose also leads to biochemical imbalances in the eye including oxidative stress, inflammation, and increased vascular endothelial growth factor (VEGF). Oxidative stress results from an excess of cell-damaging free radicals. Inflammation is the result of immune responses that can injure retinal tissue.
VEGF is a protein that promotes abnormal blood vessel growth. Together, these biochemical changes further damage the retinal blood vessels.
Managing glucose levels through diet, activity, and medication can help minimize these diabetes-driven changes in the eye.
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Semaglutide (brand name Ozempic) is an injectable type 2 diabetes medication that was approved by the U.S. Food and Drug Administration (FDA) in 2017. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists.
In addition to treating type 2 diabetes, semaglutide was FDA approved in 2021 for chronic weight management under the brand name Wegovy.
Clinical trials have shown positive cardiovascular and kidney benefits of semaglutide. But early studies also hinted at potential risks for diabetic retinopathy progression, sparking interest in further research.
Semaglutide works by mimicking the effects of GLP-1, an intestinal hormone that stimulates insulin release and suppresses glucagon secretion in a glucose-dependent manner. Specifically, semaglutide:
Semaglutide is administered once weekly by subcutaneous injection using a pre-filled pen device. The starting dose is 0.25 mg once weekly, which is then increased to 0.5 mg once weekly after 4 weeks. The dose can be further increased to 1 mg once weekly if additional glycemic control is needed.
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Clinicians today have a clearer view on semaglutide's diabetic retinopathy risks versus benefits:
Potential benefits for eye health:
Possible risks requiring monitoring:
susceptible
With routine eye exams, ophthalmologists can detect any progression and initiate treatment if needed. Many feel semaglutide's overall benefits in reducing cardiovascular events outweigh small risks.
Whether or not you take diabetes medications like semaglutide, certain healthy habits can help safeguard your vision from diabetic eye disease:
Proper diabetic retinopathy management prevents vision loss. If prescribed semaglutide or other diabetes medications, work closely with your medical team to make informed decisions about your eye health.
For many living with type 2 diabetes, semaglutide can be a safe and effective medication when combined with healthy lifestyle measures. Taking it as prescribed while monitoring blood glucose and getting regular retina evaluations will allow quick detection and management of any potential effects on diabetic eye health.
Managing type 2 diabetes involves coordinated efforts to control glucose, lower other cardiovascular risks, protect organ health, and support lifestyle changes.
Dr. V Medical Aesthetics provides individualized diabetes care, weight loss approaches, and IV infusion therapies to help patients control their blood sugar, reduce complications risks, and feel their best.
Our compassionate providers partner with patients through:
We also offer cutting-edge aesthetic treatments like botox, fillers, and PRP injections to help patients look and feel their best while managing diabetes.
Our integrated care empowers those with diabetes to take charge of their health. We'll collaborate on the treatment plan that's right for your needs and goals, ensuring close monitoring for any effects medications like semaglutide could have on the eyes or other organs.
Don't let diabetes or its complications slow you down. Our team provides the solutions and support for living better while achieving optimal blood sugar control.
Reach out to Dr. V Medical Aesthetics today to schedule your initial consultation.
You may also book a virtual consultation or call us at 850-407-2803.
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