As GLP-1 receptor agonists become a cornerstone of diabetes management, questions around their impact on diabetic retinopathy are gaining attention. This shift also raises opportunities for collaboration between PCPs and ophthalmologists, though the process for working across specialties isn’t always well defined. In this case, a practitioner asks how often our community collaborates with ophthalmology on patients who are eligible for GLP-1 RAs and how their insights shape prescribing decisions.
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Diabetic retinopathy roughly affects approximately 1/3 of patients diagnosed with diabetes and is the most common cause of new-onset blindness among adults aged 20-74 years. It is recommended that an initial dilated and comprehensive eye exam occur within 5 years of type 1 diabetic onset and at the time of diagnosis for type 2 diabetic patients. A follow-up screening should occur every 1-2 years after an initial eye exam.
Key takeaways about approaching diabetic retinopathy and GLP-1 therapy:
Endocrinology/Diabetes
"I haven’t collaborated with an ophthalmologist about starting a GLP-1 agonist. I do appreciate when they have clear notes in the chart regarding the patient’s diagnosis and treatment plan. This is another one of those benefits vs risks situations in medicine. I feel the risks of uncontrolled diabetes for retinopathy are far greater than the risks of medication use."
Family Practice
"Usually, once a year for new diabetic patients aged 45 or older… for healthier/younger patients and diabetes is well controlled, then every 2 years is reasonable. Although GLP-1 is associated with retinopathy, the incidence is low, and if a patient already has retinopathy, I would recommend seeing ophthalmology 2-3 months into the treatment. If all is ok, then every 6-12 months visit is reasonable, depending on how severe the retinopathy is. But having retinopathy does not necessarily mean patients should not be treated with GLP-1."
Family Practice
"1. I try to get my diabetics in once a year, if not biannually. If they're not showing signs of retinopathy or progression and their A1c and other measures are holding, I'd stay on current therapy. That said, you get to GLP-1s very quickly these days, sometimes right after metformin.
2. If I had someone that I thought was doing well from a diabetes standpoint (at least for the things I could measure), but ophthalmology saw retinopathy, this alone would prompt me to strengthen/increase their diabetes therapy. In a majority of people, this would be a GLP-1, either after metformin or perhaps added to an SGLT-2 inhibitor."
Internal Medicine
"I recommend all my diabetic patients have yearly eye exams with screening for diabetic retinopathy. Prescribing GLP-1s early in the disease assists with glucose control, decreasing the chances of diabetic retinopathy. If retinopathy is present, then consulting with their ophthalmologist concerning continuation of GLP-1 is a good idea."
Endocrinology/Diabetes
"Recommendations have not changed yet, and a yearly checkup is what I still ask patients to do. More studies are needed to show the cause-and-effect of GLP-1 analogs use for retinopathy problems, so we don't need to overreact yet."
We'd love to hear your thoughts. If you have an opinion on how to manage diabetic retinopathy and GLP-1 therapy, visit the full case on Healthcasts to share your suggestions.