GLP-1 Drugs and The Eye - Guidance for Health Care Providers

The following is a summary of recent guidance given by the American Optometric Association regarding GLP-1 receptor agonists and the eye:  

GLP-1 receptor agonists are powerful drugs for managing chronic diseases like diabetes, but they can rarely cause serious eye problems, such as:

• NAION (a type of optic nerve damage),

• worsening diabetic retinopathy (DR),

• and worsening age-related macular degeneration (AMD).

These issues may happen due to quick changes in blood sugar levels after starting the medication. People over 50 with a “disc at risk” (a certain optic nerve shape) are especially vulnerable to NAION.

What eye doctors should do:

• Perform a full, in-person, dilated eye exam before starting the drug.

• Take baseline photos of the retina (and possibly OCT scans) for high-risk patients.

• Follow up more closely during the first 12–18 months on the drug.

• Warn patients about possible vision risks, especially if they have other conditions like diabetes, high blood pressure, or high cholesterol.

• Tell patients to come in right away if they notice any vision changes.

• Stop the drug if NAION is diagnosed.

Bottom line: Regular eye exams and better patient communication are key to preventing serious vision loss in people taking GLP-1 drugs.

TIFFANY FRAMES!

Sonoran Desert Eye Center is pleased to announce that we now offer Tiffany eyeglass frames!  Tiffany frames are known for their distinctive blend of luxury, elegance, and timeless style.  

Tiffany incorporates classic and sophisticated designs that reflect the brand's heritage.  The frequently feature clean lines and elegant shapes. Tiffany uses premium materials such as acetate, stainless steel, and titanium ensuring durability and comfort while maintaining a luxurious feel. 

The brand's signature Tiffany Blue is often incorporated into the designs, making the frames instantly recognizable and associated with the Tiffany Brand.  Many Tiffany eyeglass frames feature intricated details, such as engraved logos, unique temple designs, and embellishments, adding a touch of opulence.  

The frames are crafted in Italy with meticulous attention to detail, reflecting the brand's commitment to quality and artistry. Tiffany regularly updates its collections to reflect contemporary trends while maintaining classic elements appealing to a wide range of consumers.  

Occasionally, Tiffany releases limited edition frames, making them highly sought after by collectors and fashion enthusiasts.  With a rich history dating back to 1837, Tiffany & Co. is synonymous with luxury and craftmanship, which enhances the appeal of their eyewear. 

Tiffany frames are often worn by celebrities and featured in fashion campaigns, further elevating their status in the luxury eyewear market.  The collection includes a variety of styles, from bold statement pieces to more understated options, catering to diverse preferences and occasions. 

Overall, Tiffany eyeglass frames embody a blend of luxury, style, and quality, making them a desirable choice for those looking to make a fashion statement. 

 

NEW VISION PLAN

We have signed up with a vision plan called "Vision Care Direct". Starting Monday we will be able to give a promotional code that our patients will be able to sign up with. This is exciting because we have so many self-pay patients and other patients who are dissatisfied with their current employer-provided plans.

This plan allows them to choose between materials only, exam only, or exam and materials plans. It also allows choices within each plan for people who want premium products vs. value products.

There are individual plans and family plans. There are also group plans available for small businesses that want to offer this as a benefit to their employees.

We think this will be a huge service for our patients. Hopefully this week we'll be offering the plan from our web page.

SLOW FALL

This has been a much slower fall than last year for the optical industry. In conversations with lab personnel, labs are producing half of what they usually produce. We are guessing it has something to do with the election.

PAPILLEDEMA

Normally the optic nerve disc is flush with the retina. In papilledema, intracranial pressure (pressure in the brain cavity) is so high that the optic nerve protrudes into the eye.

Increased intracranial pressure can occur if there are space-occupying lesions in the brain, such as tumors. There is a condition called pseudotumor cerebri where the intracranial pressure is high but there is no space-occupying lesion. The patient often suffers from headaches and ringing in the ears. It often occurs in young, overweight females. This was a patient I saw this week who came in for a routine eye examination.

A space-occupying brain lesion needs to be ruled out with imaging and often a lumbar puncture is performed to confirm the increased intracranial pressure and rule out other possible problems.

FAMILIAL DOMINANT DRUSEN

These photos show the retina of a patient with familial dominant drusen. Normally the retina has a very smooth, unblemished look. In this case, the little white dots are called drusen. Drusen are deposits of lipid between the retina and the laster beneath it. Normally drusen are associated with macular degeneration. But macular degeneration doesn't start to show until about 60 years old.

This patient is 40 years old, and received news of this condition 4 or 5 years earlier. While this has the appearance of macular degeneration, it tends to be less vision threatening. It is very rare. This is probably the third one I've seen in my 15 year optometric career.

GLAUCOMA: SILENT BLINDNESS

This patient is a good case to illustrate the importance of regular eye examinations, NOT just to get glasses or contact lenses. This gentleman is in his 50's. He presented merely to get glasses for computer and reading. He said he doesn't like to go to doctors. He see's 20/20 at distance without glasses and I was easily able to help with a great solution for computer and reading at work.

Normal intraocular pressure is 15mmHg. His measured pressures were 36mmHg! His true pressure is even higher than that because his corneas are very thin, causing me to read the pressures lower than they truly are. That kind of pressure damages the optic nerve, killing nerve fibers, and causing blind spots throughout the visual field that eventually coalesce to cause complete blindness.

The first picture is of a normal optic nerve (not his). The next one shows the "cupping" that occurs as nerve fibers die. He had significant cupping, or optic nerve damage. The bottom photo illustrates the visual field results we get when we test someone with glaucoma. I am having this patient back for a visual field test under his health insurance, and no doubt his field will look much worse than this!

This patient is relatively young and I am going to have to battle to keep him seeing his entire life. He will have to take multiple eyedrops aggressively and quite possibly will need sight-threatening surgery in the future. He will need to follow-up with me every 3 months for me to watch his nerve, his visual field, and his pressures very closely.

If I had caught this patient earlier, damage would have been much less, treatment and follow-ups would not have to be so aggressive, and chances of keeping him seeing the rest of his life would be much better. I can relate to his statement "I don't like going to doctors". But going to doctors and having to treat a disease is better than being blind and dependent on others for half of your life.

Half the people in the United States that have glaucoma don't know they have it. It is important for those fortunate people who don't need glasses to have their eyes checked periodically, just to make sure there are no problems that can be easily managed. Good vision can give a false sense of security and we shouldn't take it for granted!