Retinal Damage: Covid vax + GLP1 = Double Whammy

vascular occlusion and ischemic optic atrophy events

Evidence continues to accumulate showing the hazards arising from Covid vaccination and also GLP1 agonist therapies. Focus of this newsletter is on the retina and its blood supply.

https://www.3bscientific.com/human-eye-chart-vr1226uu,p_1471_2606.html

Covid Vaccines Damage Retinal blood flow

This huge study was published in 2023 assessing risk of occlusion for up to two years post vax:

Individuals with COVID-19 vaccination had a higher risk of all forms of retinal vascular occlusion in 2 years after vaccination, with an overall hazard ratio of 2.19 (95% confidence interval 2.00–2.39). The cumulative incidence of retinal vascular occlusion was significantly higher in the vaccinated cohort compared to the unvaccinated cohort, 2 years and 12 weeks after vaccination. The risk of retinal vascular occlusion significantly increased during the first 2 weeks after vaccination and persisted for 12 weeks. Additionally, individuals with first and second dose of BNT162b2 and mRNA-1273 had significantly increased risk of retinal vascular occlusion 2 years following vaccination, while no disparity was detected between brand and dose of vaccines. This large multicenter study strengthens the findings of previous cases. Retinal vascular occlusion may not be a coincidental finding after COVID-19 vaccination. - J-X Li

NAION non-arteritic anterior ischemic optic neuropathy

NAION is damage to the optic nerve of the eye caused by a sudden stop of blood flow to the optic nerve. It is a condition that can lead to severe and permanent loss of vision. Many cases were reported following covid vaccinations. The pathophysiology of NAION may be due to optic nerve head ischemia resulting from impaired perfusion in structurally susceptible optic nerves.

In this case report, the temporal association and worsening of the patient's NAION within days of each COVID-19 vaccination suggests that this patient's immunogenic vaccine response contributed to poor optic nerve head perfusion in her left eye.

Nonarteritic ischemic optic neuropathy (NAION) following COVID-19 vaccination. After diagnosis of presumed NAION in the left eye following initial BNT162b2 COVID-19 vaccination, this patient developed sudden worsening vision in the left eye 3 days after her second BNT162b2 COVID-19 vaccine dose. Examination revealed a left optic neuropathy with an afferent pupillary defect (APD) and densely constricted visual field. Color fundus photos showed a small cup-to-disc ratio in the right eye (A) and diffuse optic disc edema in the left eye (B) with associated splinter hemorrhages. Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) was normal in the right eye and diffusely thickened in the left eye (A, B). The retinal whitening seen along the distal inferior arcade right eye is an artifact. 6-week follow-up fundus photos and OCT RNFL are unchanged in the right eye and demonstrate resolution of disc edema and diffuse left optic nerve pallor (C, D). - K Nachbor, et al.

A systematic review of published cases of optic neuropathy following COVID-19 vaccination came out in 2022.

Sixty eyes from forty-five patients (28 females) were included. Eighteen eyes from fourteen patients (31.1%) were diagnosed with anterior ischemic optic neuropathy (AION), while 34 eyes from 26 patients (57.8%) were diagnosed with optic neuritis (ON). Other conditions included autoimmune optic neuropathy and Leber hereditary optic neuropathy. Fifteen patients (33.3%) had bilateral involvement. The mean age of all patients was 47.4 ± 17.1 years. The mean age of AION patients was 62.9 ± 12.2 years and of ON patients was 39.7 ± 12.8 years (p < 0.001). The mean time from vaccination to ophthalmic symptoms was 9.6 ± 8.7 days. The mean presenting visual acuity (VA) was logMAR 0.990 ± 0.924. For 41 eyes with available follow-up, the mean presenting VA was logMAR 0.842 ± 0.885, which improved to logMAR 0.523 ± 0.860 at final follow-up (p < 0.001). COVID-19 vaccination may be associated with different forms of optic neuropathy. Patients diagnosed with ON were more likely to be younger and to experience visual improvement. - AG Elnahry et al.

All subtypes of COVID-19 vaccines, including mRNA, viral vector, and inactivated viral vaccines were associated with optic neuropathy. However, protein subunit vaccines, such as the Novavax vaccine, were not reported as a cause of optic neuropathy in the review paper.

GLP1 agonists

I reported earlier on an American study that observed semaglutide use more than doubles the risk of the previously rare condition, NAION:

Fighting retinopathy with repurposed drugs, and another caution for GLP1 agonist drugs.

“Prescriptions for semaglutide show an increased risk of nonarteritic anterior ischemic optic neuropathy (NAION) in patients with type 2 diabetes and / or patients who are overweight or obese. A matched cohort study of 16, 827 patients revealed higher risk of NAION in patients prescribed semaglutide compared with patients prescribed non–glucagon-like peptide receptor agonist medications for diabetes or obesity.” - JT Hathaway et al

Now Denmark looked further into the association. One study of data from 424,152 Danes with type 2 diabetes revealed that semaglutide more than doubles the risk of developing NAION. A second study, done in both Denmark and Norway, compared new users of semaglutide with users of another diabetes treatment drug, who are at the same stage of the disease. They, too, have found that the risk of developing NAION doubles with use of semaglutide.

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Coincident with the current surge in GLP1 use (which includes all the black market sources) I expect to see a spike in these ophthalmic conditions leading to blindness. We are approaching the two year mark post covid boosters, when they are likely to manifest.

AAION results from inflammation and thrombosis of the short posterior ciliary arteries, which causes optic nerve head infarction. Along with vascular occlusions, they are ophthalmic emergencies and require immediate treatment.

All doctors and their patients must heed this caution. Seek treatment with the first signs of vision loss.

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REFERENCES

J-X Li, et al. Risk assessment of retinal vascular occlusion after COVID-19 vaccination. npj Vaccines 8, 64 (2023). https://doi.org/10.1038/s41541-023-00661-7

K Nachbor, et al. Nonarteritic Anterior Ischemic Optic Neuropathy Associated With COVID-19 Vaccination. Journal of Neuro-Ophthalmology 43(4):p e111-e113, December 2023. | DOI: 10.1097/WNO.0000000000001423

JT Hathaway, et al. Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide. JAMA Ophthalmology (2024). DOI: 10.1001/jamaophthalmol.2024.2296

AG Elnahry et al. COVID-19 Vaccine-Associated Optic Neuropathy: A Systematic Review of 45 Patients. Vaccines (Basel). 2022 Oct 20;10(10):1758. doi: 10.3390/vaccines10101758.

J Grauslund, et al, Once-weekly semaglutide doubles the five-year risk of nonarteritic anterior ischemic optic neuropathy in a Danish cohort of 424,152 persons with type 2 diabetes. International Journal of Retina and Vitreous

E Simonsen, et al, Use of semaglutide and risk of non-arteritic anterior ischemic optic neuropathy: A Danish–Norwegian cohort study, medRxiv (2024). DOI: 10.1101/2024.12.09.24318574