Anti-obesity medications impacting the eye: An emerging concern - a narrative review

Table 1 Various anti-obesity drugs and ocular side effects

Drug/class	Ocular adverse effects	Incidence	Mechanism	Ref.
Semaglutide (GLP-1 RA)	NAION, DR progression, possible neovascular age-related macular degeneration	Very rare (approximately 1:10000)	Microvascular compromise, rapid glycemic shifts	[39,42-45,47,50]
Tirzepatide	NAION, bilateral papillitis, paracentral acute middle maculopathy, lower cataract risk		Rapid glycemic shift	[39,48-50,81]
Topiramate	Acute angle closure	3 per 100000	Ciliochoroidal effusion	[61-65,73]
Phentermine	Angle closure glaucoma, visual hallucinations, retinal vasoconstriction, and anterior ischaemic optic neuropathy	-	Sympathomimetic effect	[66,67,69-71]
Naltrexone-bupropion	Blurred vision, rare glaucoma	Unclear	CNS/anticholinergic	[50,72,73]
Orlistat	Indirect icterus	Unclear	Secondary to hepatotoxicity	[74]
Setmelanotide	Scleral, periocular discoloration	Not mentioned	Metabolic or hepatic effect	[80]

GLP-1 RA: Glucagon-like peptide-1 receptor agonist; NAAION: Non-arteritic anterior ischemic optic neuropathy; DR: Diabetic retinopathy; CNS: Central nervous system.

Table 2 Mechanisms of anti-obesity drug-induced visual impairment

Mechanism	Description	Examples
Vascular	Ischemia due to altered ocular blood flow or microvascular injury	GLP-1 receptor agonists (NAION)
Metabolic	Indirect effects, such as rapid glycemic improvement or hepatic dysfunction	GLP-1 receptor agonists (DR)
Direct drug toxicity	Physical or chemical injury to ocular structures	Topiramate (anatomic shift, effusion)

GLP-1 RA: Glucagon-like peptide-1 receptor agonist; NAAION: Non-arteritic anterior ischemic optic neuropathy; DR: Diabetic retinopathy.