Jardiance (Empagliflozin) is being commonly used to treat patients with Diabetes mellitus Type 2.
It has been recently approved for the treatment of patients with heart failure and preserved ejection fraction.
Jardiance has already been approved to treat patients with heart failure and reduced ejection fraction.
Jardiance can have direct and indirect effects on our eyes. Although eye-related side effects have not been mentioned in the FDA-prescribing information of Jardiance, patients report eye-related symptoms when started on Jardiance.
How Jardiance can Affect Our Eyes?
Jardiance (Empagliflozin) is a class of medicines called SGLT2 inhibitors. These drugs help lower blood glucose by inhibiting the reabsorption of glucose from the kidney tubules.
This causes more of the filtered glucose to be lost in the urine. As glucose is lost, it draws water with itself resulting in water loss from our bodies. This is called osmotic diuresis.
Jardiance side effects on the eyes may be a result of this fluid loss since our eyes have got a very high water content.
Dehydration due to any reason may cause the following eye-related effects:
- Dry eyes
- Refraction errors
- Retinal vascular diseases
Jardiance, Dry Eyes, and Diabetes:
Dry eye syndrome or keratoconjunctivitis sicca is a common condition affecting the eyes. It affects 15 to 33% of patients with diabetes mellitus type 2. The prevalence of dry eyes increases with age and may affect up to 50% of women with diabetes [Ref].
Patients with dry eyes may have gritty eyes, blurred vision, soreness, photophobia, and reduced visual acuity.
Hyperglycemia causes the formation of glycated end products that are found in abundance in tears and may be used as biomarkers for the diagnosis of diabetes-related dry eye syndrome.
Fluid loss as a result of osmotic diuresis can cause symptoms of dry eyes. Thus, patients may notice blurring, gritty sensations in the eyes, and pain when started on Jardiance treatment.
This effect may be more pronounced during the initial few weeks of treatment. However, as the body gets used to the effects of Jardiance, these side effects go away.
Jardiance Side effects on the blood vessels of eyes:
Jardiance is associated with an increase in osmolality of the blood. This is again because of the dehydrating effects of Jardiance.
The blood vessels in our eyes are especially prone to slight changes in blood viscosity. Just like Jardiance increases the risk of stroke, patients on Jardiance can also develop thrombosis of the blood vessels.
Retinal vein thrombosis can cause sudden vision loss and blurred vision. Data from National Health Insurance Service in South Korea was evaluated to see any association between SGLT2 inhibitors and retinal vein thrombosis in Diabetic patients.
The data showed a significant association between retinal vein thrombosis and SGLT2 Inhibitors use. Elderly patients and patients with chronic kidney disease were especially found to be at risk of developing retinal vein thrombosis [Ref].
Jardiance association with Cataract Formation:
A cataract is common in older diabetic patients compared to the general population. Data is limited to clearly associate the use of Jardiance with Cataracts. However, a phase 4 clinical trial has found an increased incidence of Cataracts in diabetic people using Jardiance.
Cataract formation was common in patients who were using Jardiance for more than one to two years. Among those who developed cataracts, 80% of the individuals were older than 60 years of age.
Jardiance effects in patients on diabetic retinopathy:
Jardiance has not been associated with an increased incidence of diabetic retinopathy. Rather, it may, directly and indirectly, reduce the progression of diabetic retinopathy.
Since Jardiance lowers the A1C, it reduces the development of glycated end products. Glycated end-products are primarily involved in the pathogenesis of Diabetic Retinopathy.
Thus, Jardiance reduces the progression of diabetic retinopathy indirectly by lowering blood glucose.
Jardiance has also been hypothesized to directly affect the vasculature of retinal eyes. In one case report, an elderly woman with proliferative diabetic retinopathy who was resistant to intravitreal corticosteroid injections was treated with an SGLT2 Inhibitor after she developed macular edema.
Patients markedly improved within four weeks. Her visual acuity started improving within four weeks. The improvement progressed to a visual acuity of 22/24 within 24 weeks [Ref].
The authors stated that the effects of Jardiance on Diabetic Retinopathy was not secondary to a reduction in A1C since the improvement was too rapid plus the reduction in A1C was just 0.2%.
Jardiance side effects on the eyes may range from mild symptoms like dryness and blurred vision to severe eye symptoms as a result of retinal vein thrombosis and cataract formation.