Why Did Todd Engel Lose His Sight?

New Brunswick, NJOn April 24, Todd Engel filed an Ozempic lawsuit in the Superior Court of New Jersey, Middlesex County, alleging that Novo Nordisk failed to warn him and his doctor that taking Ozempic increased his risk of nonarteritic anterior ischemic optic neuropathy (NAION), an irreversible form of blindness. NAION is one of the dangerous side effects often linked to Ozempic, although Novo Nordisk has consistently maintained that NAION is not an adverse drug reaction to Ozempic and other GLP-1 RA class drugs. To reduce the manufacturer’s argument to a legal maxim, “correlation does not imply causation.”

Legally blind

Engel’s doctor prescribed him Ozempic in 2023 to manage his Type 2 diabetes. Roughly four months later, he was diagnosed with NAION. He first experienced loss of vision in one eye before eventually becoming legally blind in both. His condition forced him to resign from his job as a motor equipment operator for his county’s public works department, made it impossible for him to drive and has changed how he interacts with family and friends. Engel has said that if he had known Ozempic had a possible link to blindness, he would have considered other treatment options for his diabetes.

Symptoms of NAION

Early symptoms of NAION-related vision loss can include:

loss of vision upon waking;
dark area or shadow in vision;
blurred vision;
color vision loss;
loss of contrast;
light sensitivity;
periocular eye pain; and
headache.

If you are taking Ozempic and have any of these symptoms, you should see your ophthalmologist promptly.

Legal theory of negligence

The theory of negligence, on which the lawsuit turns, requires that the plaintiff prove four basic things:

If it knew that Ozempic could cause NAION blindness, Novo Nordisk had a duty to warn Engel and his doctor of that risk, so that Engel could make an informed decision;
The company failed to do that;
Ozempic caused the harm that Engel suffered; and
Blindness is a real, substantial harm.

The second and fourth elements are straightforward. The third element – causation – is the problem. If Ozempic is not the culprit then, of course, Novo Nordisk had no duty to warn Engel of the danger.

There seems to be evidence on both sides. It is worth noting, however, that the standard of proof Engel and his lawyers must meet is only “preponderance of evidence.” It must be only more likely than not that Ozempic caused his blindness. It need not be beyond any doubt.

Was Ozempic the culprit?

A February 2025 study published in JAMA Ophthalmology examined the records of 37.1 million adults suffering from Type 2 diabetes and found a small increase in the incidence of NAION in patients exposed to semaglutide drugs, like Ozempic. This follows a smaller 2024 study also published in JAMA Ophthalmology, which found that the use of semaglutide-containing drugs was associated with a much higher risk of NAION than the population in general. The risk of NAION was more than four times higher for diabetes patients. For those taking it for obesity, the risk was more than seven times higher.

On the other hand, Novo Nordisk insists that NAION is not an adverse drug reaction to Ozempic and other GLP-1s. The company cites an evaluation of studies from the University of Southern Denmark and an internal safety assessment, which did not suggest a causal relationship between GLP-1 use and NAION. Instead, Novo Nordisk asserts that eye conditions are a well-known comorbidity for people living with diabetes. So, was it Ozempic, or the underlying Type 2 diabetes?

If Engel’s Ozempic lawsuit goes to trial, much will depend on the relative strength of the scientific evidence presented by each side. This is likely to turn into a duel between expert witnesses. The process of discovery will develop this in greater detail and may ultimately result in a settlement agreement.