GLP1 Agonists Impact on Retina

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Jan 19, 2024
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Hello everyone,

I am an ophthalmology resident who is interested in retina surgery. Retinal pathology and surgeries stand out to me as my favorites I have encountered thus far. That said, the overall health of retina as a profession is also of relevance when deciding whether or not to undergo a 2 year fellowship.

GLP1 agonists seem poised to significantly reduce obesity, diabetes, and presumably diabetic retinopathy. Despite some reports of rapidly decreasing sugars producing a temporary worsening of PDR, if there was to be widespread use of GLP1 agonists as an early intervention on obesity, it seems very likely that less people would ever develop diabetic retinopathy. Clearly this is a great thing for patients. Due to recent data showing decreases in strokes and MI, GLP1 agonists seem poised to enter the pantheon of widely-prescribed drugs like statins and beta blockers.

Many businesses are involved with either causing or treating obesity, and a decrease in the obesity rate would impact them. GLP1 agonists are causing financial ramifications across the economy, from fast-food companies to the makers of insulin pumps. (Medtech can cope with GLP-1s but ‘fear and doubt’ suppressing stocks: analysts)

I am curious how you all view the potential impact on retina of a population-wide decrease in obesity and diabetes. A few questions:
- What percentage of an average retina practice consists of diabetic retinopathy patients?
- How saturated is retina with doctors at present? Would a 10-20% reduction in patient volumes significantly harm the field?

Thank you for your thoughts.

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Once you are into the world of retina, you’ll see that retina Includes a wide variety of pts, and DR pts are just one of many. Yes, they make up a good portion of most retina practices but I don’t see the GLP1 drugs having a detrimental impact. You gotta remember, a fair number of diabetics will not be able to tolerate these drugs. Also, I’ve got quite a few pts who are on these drugs but continue to eat and remain obese (it’s like they lose weight and then hit a wall without further improvements). Pts are also always going to find ways to be non-compliant giving themselves these injections. The negative effects of a high A1C are not showing up in current time but appear as accumulated damage down the road. Even if all these GLP1 using diabetics were able to suddenly achieve a “perfect” A1C, the damage from their previous poorly controlled sugar levels would show up as damage no matter what
Have you seen how old the average eye clinic patient is? Aging is bad for the eyes. The biggest negative impact on patient volumes is patients dying early. Any intervention like these GLP drugs that helps them live longer will increase all sorts of eye diseases (including AMD) because, if you live long enough, you will get an eye problem eventually. (This is the counterintuitive reason why prevention does not necessarily lower overall healthcare costs, even though it’s good for patients - if you live longer, you will likely use more healthcare).

But unfortunately the limiting factor is not patient volume, it is healthcare dollars and Medicare solvency. As more baby boomers age, and as we waste valuable healthcare dollars on treatments with no noticeable functional benefit for patients (such as the GA drugs amongst many others) our reimbursements will be cut even further and patient volumes increased to burnout levels.
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Thank you both for your insights! My perspective may be skewed by my training program being in a low SES area in which a very high proportion of patients have diabetes. It makes up definitely more than half of all retina visits for us.