CEimpact Podcast

GLP-1 Therapy and Ocular Disorders

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GLP-1 receptor agonists have revolutionized the treatment of diabetes and obesity, but recent data suggest a potential link to a higher risk of various ocular disorders, especially with long-term use. This episode reviews the findings of these studies, places them in context with the overall benefits of GLP-1s, and covers what pharmacists should know when counseling patients. Listen in to enhance your ability to guide safe, informed medication choices and stay updated on emerging safety information.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Jamie Pitlick, PharmD, BCPS, BC-ADM
Professor and Chair of Pharmacy Practice
Drake University College of Pharmacy and Health Sciences

Joshua Davis Kinsey and Jamie Pitlick have no relevant financial relationships with ineligible companies to disclose.
 
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the potential relationship between GLP-1 receptor agonist use and the development of ocular disorders.
2. Identify key considerations for pharmacist counseling related to GLP-1 therapy and ocular health.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-311-H01-P
Initial release date: 10/27/2025
Expiration date: 10/27/2026
Additional CPE details can be found here.

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SPEAKER_00:

ACE Impact subscribers, welcome to the Game Changers Clinical Conversations podcast. I'm your host, Josh Kinsey, and as always, I'm excited about our conversation of the day. GLP1 receptor agonists continue to make headlines for their expanding role in chronic disease management, but new research suggests they may also affect ocular health. In this episode, we'll discuss what pharmacists need to know about potential risks to ocular disorders with long-term GLP1 therapy and how to handle these concerns in everyday practice. And it is great to have Jamie Pitlick with us as our guest for today. Jamie, so nice to see you.

SPEAKER_01:

Good to see you.

SPEAKER_00:

Yeah. Welcome. Go ahead and tell us a little bit about yourself. You've been a guest on the podcast a few times, but it's been a while. So we have a lot of new listeners. So let's go ahead and uh give you a couple minutes to introduce yourself and tell us a little bit about your practice site.

SPEAKER_01:

Absolutely. Like you said, I'm Dr. Jamie Pitlick. I am a professor and chair of pharmacy practice at Drake. I've been at Drake for about seven years. I do have a practice site, even as chair. I'm practicing at least one day a week at Iowa Diabetes. Prior to being the chair of pharmacy practice, I was there much, much to a greater extent, but practicing kind of in the either primary care or endocrinology practice for my whole career since I started as in the academia world.

SPEAKER_00:

Yeah, great. That's great. Yeah. And coming previously from academia, I I can't imagine why you don't have time to practice more if you're chair of the department. Yeah, I'm just so baffled. Yeah, I know that's a lot of work. So, but also along those same lines, again, further reiterating the fact of you're giving time out of your schedule to record this with us. So I really appreciate it. So as I mentioned earlier, we're going to talk today a little bit about GLP1 Receptor Agonists. And as we always like to do, just to kind of set the stage for our listeners and make sure that everybody is on the same page. Let's review all of the great things about GLP 1 Receptor Agonist, Jamie, that we have seen their use just continuing to expand. So just refresh our memories on what all we're seeing them used for currently, the spaces that they're in. And just, you know, it shouldn't be news to anyone because it's been all over the news, but let's just review that if you don't mind for a minute.

SPEAKER_01:

Yeah. So GLP1s have been out for a number of years. I think the first one by Eddie came out while I was in pharmacy school. There are people that are using a xenotide, but it is not the one that is used extensively. Now we're using more semaglutide or trisepatide, so Ozempic or Mundaro, using the brand names for those. So with those medications, they're primarily used for diabetes, lowering the glucose levels. And they're heavy hitters, lowering over 1%, sometimes 2% on the A1C. So great glycemic control and benefits coming from them. But because of the other effects that it's doing on the body, slowing down weight loss or sorry, slowing down how fast the food moves through the body, making you feel full faster, feel full longer, we're seeing significant weight loss, especially with those last two, the semiglatide and trisepatide. And with the trisepatide, just to be 100% clear, it is a dual agonist. So it's working on two different uh increotin hormones in the body. It's the GLP1 and the GIP. So it's kind of hitting two of those mechanisms. So with that weight loss, though, we're getting to see other benefits from, and you will see news articles, you will see medical journal articles coming out all over about it. I did a talk last year on this, and just the amount of articles I collected on it, it was like chronic kidney disease. There's some magliotide and heart failure, trzepatide being studied in MASH, which is the new version of MASH. Now we're calling it MASH.

SPEAKER_02:

Yep.

SPEAKER_01:

Trzepatide also has the evidence for use in sleep apnea. They're looking at it in peripheral arterial disease and also very, very preliminary studies in Alzheimer. So you named some of the big disease states, especially if it's hitting a metabolic pathway, they're looking at studying it.

SPEAKER_00:

Yeah, yeah. And some really promising things too. I mean, obviously, we we've already seen the promise and the success of weight loss. And, you know, if you think through the process, it makes sense for sleep apnea because typically if someone is losing weight and their glucose gets controlled and, you know, all that kind of stuff, then it makes sense that their sleep patterns are better. Um, so yeah, so I think, you know, the the reason for today's episode, we've had a few other episodes on GLP1s, and I encourage listeners to go back and listen to those because we really hype up a lot of those new things and the promising potential therapeutic uses of GLP ones. But today's topic is really kind of to dig into a couple of articles that have recently been published. And Jamie and I were talking about this before, it's kind of the first time that there's been some true negative press around GLP 1s. And I don't think it's really picked up a lot yet. But we wanted to kind of dissect these two articles and really look at and see if GLP1s have a negative effect on some ocular disorders, because that's what these studies suggest. So, and at least, you know, if if there is that direct causal link, then we want to train you all as pharmacists as to what what you're supposed to do, what you need to know and how you need to manage those and monitor those and things like that. So, so Jamie, would you let's just let's go and start with article one. So, article one is we're gonna be looking at an article that was published recently in JAMA and it was published in August, an online um uh version of this. And it's a semaglotide or trzepatide and optic nerve and visual pathway disorders and type two diabetes. And the original kind of question that they ask here, and this is what I'll pose to you first, so this is kind of kind of set it up, Jamie, is is treatment with either somagaltide or trzepatide associated with an increased risk of non-arteritic anterior ischemic optic neuropathy and other optic nerve and visual pathway disorders? So let's take a closer look at this article. If you want to walk us through maybe kind of what the study found and why it's gaining some a little bit of attention.

SPEAKER_01:

Yeah. So the what they looked at was examining whether these two medications, so the smiglide and trisepatide, if they have an impact versus other anti-diabetic medications on the eye health. And they're specifically looking at the optic nerves and some of those ICD 10 codes that go into the optic nerve diagnoses. So it is a retrospective cohort study. So they took an existing group of data and it was through. Let me just verify the name of the data set that they use, but it was like trial trying to find the exact wording of it.

SPEAKER_00:

I saw it recently too, and now it's off my screen. Hold on. I'll make a note of this so we can edit this. And then when you find it, just say that you just go back to the like.

SPEAKER_01:

And I had all these things highlighted too. Um yeah. Okay, so this is a retrospective cohort study which examined data that was available through this platform called TriNetX. And all the data was collected and analyzed to see if semeglatide and trisephatide combined were different than all the other anti-diabetic medications. Um, just to define what those anti-diabetic medications were, it included not only metformin, your sulfonurias, it included actose, it included also other GLP1s that are considered weaker GLP1s. So they looked at laroglutide, axenotide, and tansium, which is off the market now, but they looked at all of those kind of bundled together in that other category. So they looked to see if the diagnosis of these optic nerve disorders was more common if you were on semegalotide and trisepatide versus all these other drug classifications. And they looked at a huge number of patients. It looked like it was over 2 million records that they looked at and eventually whittled it down. Um, and they had about 80,000 patients on semegalotide or trisepatide versus about a million, over a million on all these other medications. And that's the number of patients and everything that they looked at. So it was a huge data set.

SPEAKER_00:

Yeah.

SPEAKER_01:

The other thing is they looked at diagnosis codes. So they looked at ICD-10 codes to see if they were more common or not. And there's a whole series of diagnoses codes that they looked at. Only one of them was that one very specific to the optic nerve, which is A N A I O N, so non-arteritic anterior ischemic optic neuropathy. And that was a very specific diagnosis code that they then honed into, but they looked at all sorts of other ones as well. Now, for those of you that are like me that had no idea what that was, I did have to look this up. It is like a blockage of the artery going to the optic nerve.

SPEAKER_00:

Okay.

SPEAKER_01:

And it is a disease that's caused and has other risk factors. One of them is diabetes, one of them is hypertension, but there's a all sorts of other things that go into that diagnosis and that risk and disease state. So it's many things can cause it essentially. So they looked for this association between is this diagnosis or these different kinds of diagnoses more common for trisepatide and semaglide. And what they found was for the NAION, it was more common. So there was a higher risk. So the hazards ratio was worse if you had semaglide, had exposure to semaglide or trusepatide. In some of the other optic nerve disorders, there was a small increase as well. And that was for literally what it said was other optic nerve disorders. And then they listed what those ICD 10 codes were. I did not go in and actually see what those ICD 10 codes were, just kind of categorized as they did find no difference for a few disorders as well. So just to say that there was no association for optic nerve neuritis, papillar edema, and optic atrophy. So those had no association whatsoever. So I found it interesting that there was the small increase. Now, what I found really interesting in the results was out of, I gave you those big numbers, out of the 80,000 patients that had exposure to trisepatide or semegalotide, 35 patients in two years got this disorder, got the NAION.

SPEAKER_02:

Okay.

SPEAKER_01:

So very small amount in a percentage that was at 0.04%. So very small risk.

SPEAKER_02:

Yeah.

SPEAKER_01:

And that was compared to 19 people in the matched cohort that had no exposure to those two drugs. So 35 patients versus 19. But because the population size was so big, that statistically was a difference. Okay. So if you look at the absolute difference between those two percentages, it was 0.04 minus 0.02. So like 0.02% difference between the results.

SPEAKER_02:

Okay.

SPEAKER_01:

So it it was statistically happening more often, but the rate at which it's happening in the population is very, very rare. I think it's good for pharmacists and anybody going on the drug to know that you know there is an increased risk. There's an increased risk. But the absolute risk is very low. And if you look at the benefits of these drugs in all the other disease states, how much it's lowering A1C over 2% some cases, how much weight reduction you can get if you used it combined with proper diet and exercise education, you can get 15% weight reduction, sometimes anecdotally more. And then you we have cardiovascular disease FDA approval for that and benefit. So you look at the absolute risk reduction it's doing to benefit the patient versus that little harm. I feel like your your data still eskewing towards the benefit side of it.

SPEAKER_00:

Absolutely. Absolutely. And you know, just in general, you know, we we alluded to it, but pointing out that, you know, losing the weight and that's gonna bring down blood pressure, and then that's going to, you know, help with any sort of other like sleep apnea or it's gonna allow you to exercise more and continue, you know, so it's just it's it's literally just this kind of cascade effect that these medications cause. And like you said, when you're when you're truly weighing those benefits versus the risks, does this really stand out as oh, so maybe we don't start GLP1 because they have a very minute chance of getting this very obscure, you know, version of an optic disorder? So yeah. So that's that's super helpful. So that was the first study. So again, yes, the link is there, but you know, the significance of that link and when weighed to other pros and cons, does it still make sense to avoid initiating a GLP1 or continuing a GLP1? So then there is a second study that we'll look at, and then we'll kind of summarize and talk through some things and give some pointers for what we can do in practice. But the second study also published on JAMA, and it was published in July of this year, 2025, and it says GLP1 drugs link to higher risk of age-related macular degeneration. And kind of the setup to this one is people taking glucocon-like peptide GLP1 receptor agonist had a higher risk of neurovascular neovascular age-related macular degeneration in a retrospective study, which built on previous findings linking these medications to vision impairment. So again, it appears that we have another retrospective study, and I'll kind of let you do the same kind of outline for this one, Jamie, and then we can kind of just summarize our thoughts and whether or not this should give true pause or concern for initiating GLP1s. Um, but yeah, go ahead and let's talk about this study a little bit.

SPEAKER_01:

Yeah, and this one I didn't have quite as much detail on it, but it it is showing that age-related wet macular degeneration. So with that disorder, you have new blood vessels forming in the back of your eye. And it's deemed wet or dry based on if those blood vessels burst or not. Obviously, wet is considered a slightly more serious than the dry because then you're starting to get more acute vision loss and risk for that to happen. Um, so do the GLP ones possibly increase that again, retrospective cohort study analyzing the the risk of that exposure for GLP ones. So all the limitations of a retrospective study that we've already kind of talked about, where it's causation, it's not causation, it's correlation, um have to be taken into mind. And then the other thing with the macular degeneration, again, high blood pressure, diabetes itself are risk factors for it. I did read a slightly different study and brought up a different study that said there might be an increase in immediately after starting the medication, but long-term effects of it are unknown. Um so and why I bring that up, I liken that a little bit to some recent, not recent, but some findings that we have about SGLT2s. SGLT2s worsen renal function acutely.

SPEAKER_02:

Right.

SPEAKER_01:

After we worsen the renal function, it stabilizes and it becomes renal protective.

SPEAKER_00:

Protective, yep.

SPEAKER_01:

And there's suggestions or they're starting to look into that direction. Do you acutely worsen this disorder? And then does it long-term stabilize or what happens? And they're actually doing some studies, not on macular degeneration, but more in diabetic retinopathy on that with some magnetide in the focus study. So they're they're looking in terms of that. So again, it's something that I give pause to, but with the study being retrospective and kind of short window of time, it's hard to know what what to do with that information yet.

SPEAKER_00:

Right. Because I think that most recent study was like only six months of therapy, right? Like so it wasn't even it wasn't even long-term use. And how many of our patients are on GLP1s for a greater length of time than that, you know? So yeah.

SPEAKER_01:

Right.

SPEAKER_00:

Yeah.

SPEAKER_01:

Yeah. So it's yeah, it's what's happening long term that I want to learn more about and figure out more about. I like these articles both. I think it is very necessary to be aware of this so that we can educate our patients, educate our providers about the information. As you know, things can go out to patients. And so you never know what they're going to listen to or read. And we have to be prepared to address all of their concerns. Absolutely. So I think knowing that, and then just saying, you know, their short term, again, balancing the risks versus benefits of the whole medication. So the risks to the eyes versus the benefits that we've already talked about. The other thing I wanted to bring into play is I do think it's a known thing, but it's something that we sometimes forget about. There was a signal that happened when cemeglide was first studied and released. Because cemaglide is so potent and it drops your glucose so far and so fast, it actually was triggered to show that it possibly could increase your risk for diabetic retinopathy. Insulin has the same signal that happens because if we go and take somebody's sugar who's glucotoxic in the A1Cs of over 10%, and we quickly drop them, the same thing happens where you increase their risk for diabetic retinopathy. That is a known thing with all insulin products. If you read their package labeling, you'll you'll see it in there. The exact mechanism of why that happens is not 100% known. Is it the change in blood sugars in the eyes? Are we changing the fluid levels like the osmotic pressure that's happening in the eyes? So there's a lot of speculation about what's happening, but these are potent drugs that can really drop your glucose fast. So in practice, when we see somebody who has risk or has history of diabetic retinopathy who's coming to us with A1Cs over 10, we do want to get their blood sugars down, but we do it in a very slow, very processed manner. So if somebody's young and healthy, we may drop them faster. But somebody who has that eye history, we're a little bit more careful because we don't want to trigger any sort of problems with our eyes. So we do take it a little slower.

SPEAKER_00:

Yeah. And you know, what I'm hearing there is that this is the information from these studies. Um, while, like you said, it gives us, you know, maybe pause for concern and to think through it a little further and to to weigh pros and cons heavily for our older patients, especially if they already have a history of some sort of ocular disorder. But it's also not new to pharmacists, right? So we're used to these things that occur that require that beautiful term called monitoring. Um, and so making sure that we are monitoring our patients and that we're following, doing follow-up care appropriately. And I think that that is just it's further proof that, you know, these are two things to be on the lookout for and to be mindful of. But I don't think it it changes our decision of whether or not to start someone on a therapy right now. At least, you know, again, maybe certain individuals get a bigger discussion and maybe perhaps it's a collaborative discussion with other members of the interdisciplinary team. But I think it's important just to note that it's also important just to know that this exists and the possible link is there to monitor the patients and to really be be mindful of um uh follow-up care and things. So another and another thing you mentioned that I'll reiterate is of course, just like you said, we never know when this information is gonna leak out to our patients. And so they're gonna come to you and ask questions and say, Well, I'm not taking this anymore, even though it's helped me lose a lot of weight and it's got my blood sugar under control, and now I don't have to use my sleep apnea CPAP machine. But I heard that it will cause, you know, an issue with my eye and I'll go blind. So, you know, that could very well be the next wave of things that the patients come through and ask about. So I think, you know, one of the key reasons we wanted to talk about it again was to make you aware as a pharmacist so you're not caught off guard and so that you do have the facts now that you can discuss and educate your patients on. So one thing I wanted to go into again, you mentioned, you know, the challenge of these studies is again the the limited the fact that it was retrospective and certain things that, you know, give us greater pause as well. But one of the other things that I, you know, I talked about collaborating. Any tips or tricks that you've seen with communicating with other members of the team on something like this? When you're if it's if the issue has been raised and now should we stop the therapy or if it's talking about whether or not to initiate it, like what are some of the things, what are some of the conversations and tips and tricks you can share with our listeners to kind of help in that that discussion?

SPEAKER_01:

Yeah, and just in all transparency, I work in a clinic. So I'm working right next to the nurse practitioners, the PAs, the doctors. And so as the patients are asking me questions, I'm letting, I'm answering them just as I say. Like, here's the absolute risk, here's what it can cause, but look at what it's done for you. And then I'm talking with the provider right next to me and say, they've got questions about this. They might ask you additional questions. Here's the information, here's the study, and I give them kind of a little bit of a synopsis of the study, two-minute summary, and then let them know what I know to help them have a similar message for the patient.

SPEAKER_02:

Sure.

SPEAKER_01:

One of the things I hear a lot of times that the patients unfortunately they they're like, I don't know who to believe. The internet's saying this, this doctor's saying this, this person's saying this, and then who do who do I believe? Sure. And so if we can have a similar message across the board and be kind of that trusted clinic, essentially, and cause less confusion.

SPEAKER_00:

Yeah, that's great. And you know, something I always used to tell this my students as well is it's important to when you when you do have an opinion and you do have, you know, it's backed with evidence-based studies or recent articles or whatever, it's important to share that with the person you're collaborating with and talking to, as opposed to just saying, oh, I've already done all the research and here's the answer. So, you know, relay that. It's it's important, right, to make sure that we're giving the evidence so that they can make an informed decision, but we're also definitely sharing our opinion and making sure that they have the facts. But in in the same sense of also, you know, if we're going to if we have done the risk assessment and we've determined that someone should no longer continue on a GLP one in this case or any other kind of medication, depending on what we're looking at. Um, it's also important to be sure that you have an alternative plan when you go to that other provider as well.

SPEAKER_01:

What? What?

SPEAKER_00:

Exactly. You can't just say we can no longer do this because you're the medication expert, so you need to have a plan in place. So that's something else that I'll reiterate to our listeners is again, sometimes it will take some discussions with other members of the team and always have your facts and details ready. Share your opinion, but share also where you where you formed your opinion so that they can also form theirs. So again, I think in summary, Jamie, for today, our our take home is that because my take home at least, and I'll let you agree or add to my take home is that because these medications are so popular right now and are coming up with so many different uses and being used in a lot of patients, I think these types of studies are gonna continue to creep up. We're gonna continue to see, hey, here's a pause for concern, hey, here's a potential link. And so what would you say is like the take-home message for our listener with that? Like, this is not gonna be the last time we see a GLP1 potential negative effect come out in a study. So what's your take-home point for that?

SPEAKER_01:

Yeah, I would say always encourage them to continue to take their medicine until talking with their provider so they can come up with a plan in terms of this particular area with the eyes. And if they're using it for diabetes, recommending that they're doing the yearly eye follow-up. The dilated eye exam is key because it will catch the diabetic retinopathy, it'll catch macular degeneration, it'll catch glaucoma, all of these different things that can pop up and happen. As a, I'm also a diabetes educator. And as somebody who has that background and working with these patients, I would say the eye monitoring is one of the ones that all of our patients are pretty low on because I can't control it. We can control when the foot exam happens. We can oftentimes control the flu vaccines and some of the other things, but I can't control that eye piece. And so getting that and recommending that is so very important.

SPEAKER_00:

Well, and Jamie, I would say too, you know, it's it, I think it's probably one of the things that we as pharmacists often forget about too, because those are, you know, that that the eye world is not one that we're typically involved in. And so it's we don't have a lot of collaborative, you know, efforts with those team members because it is, you know, not as common, I guess you would say. As, you know, interacting with the cardiologist and endocrinologists and the other specialists. So I think that, you know, not only is it something that's probably forgotten by a lot of patients or pushed down the list of priorities for a lot of patients, but I would also think that unfortunately we as pharmacists forget sometimes that that's a member of an interdisciplinary team for a patient with diabetes. So yeah, so I think that's a that's a key take-home point here as well. So I think we've done it, but I'll let you summarize one more time. What do you think? I always like to finalize the topic for today, but what do you think is the game changer here? You know, what what is the one thing for our listeners to walk away from today's session on?

SPEAKER_01:

I think that there are risks, risks, and benefits to the GLP1 class. This is the newest one, is going to be the risk to the optic nerves and some of the disorders that we talked about today. The absolute risk of it is very low, looking at the overall number of patients that develop disease, but it is potentially there. The benefit, though, in how much weight loss, how much A1C, the cardiovascular disease prevention, you always have to weigh that outs that side of it as well.

SPEAKER_00:

Yeah. Yeah, absolutely. Yep. So again, using your clinical knowledge as a pharmacist to weigh the pros and the cons and make an informed decision, which often requires collaboration with the other members of the team. So yeah, so I think that's key. Well, Jamie, thank you so much for your time. Again, I appreciate you giving us a few minutes of your busy schedule. We really appreciate it. So thanks for joining us today.

SPEAKER_01:

Thank you.

SPEAKER_00:

If you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpact.com. And as always, have a great week in Keep Learning. I can't wait to dig into another game changing topic with you all next week.