Latest news with #JAMAOphthalmology
Medscape
20 hours ago
- Health
- Medscape
GLP-1 Users May Face Optic Nerve Damage Risk in First Year
TOPLINE: The use of GLP-1 receptor agonists, and particularly liraglutide, was associated with an increased risk of developing nonarteritic anterior ischemic optic neuropathy (NAION) during the first year of treatment, with the risk being most pronounced in individuals without type 2 diabetes (T2D) or obesity. METHODOLOGY: Researchers conducted a case-control study to examine the association between the use of GLP-1 agents and development of NAION. They analyzed data from 65,612 patients with NAION who had obesity, T2D, or neither and matched them with 641,751 control participants by age, exact year of insurance enrollment, and history of T2D or obesity. Exposure to GLP-1 was defined by use (ever or never) and duration of continuous use (1, 2, or ≥ 3 years), according to dispensed prescriptions for dulaglutide, liraglutide, semaglutide, or exenatide. TAKEAWAY: The use of any GLP-1 agent was associated with 19% higher odds of developing NAION in the first year (odds ratio [OR], 1.19; 95% CI, 1.02-1.39), with the use of liraglutide tied to an even greater risk for the condition (OR, 1.53; 95% CI, 1.18-1.98). The association between exposure to a GLP-1 drug and development of NAION was stronger in people without T2D or obesity using any of these medications (OR, 2.03; 95% CI, 1.07-3.85) and especially liraglutide (OR, 2.32; 95% CI, 1.04-5.20). IN PRACTICE: 'The aforementioned associations for extended semaglutide use and liraglutide use among individuals without obesity or T2D are interesting, given these medications are increasingly being used for weight management,' the researchers reported. 'Future research including reasons for GLP-1RA [receptor agonists] use among this group and larger sample sizes could clarify whether these associations exist in this population or result from obesity or T2D diagnosis exposure misclassification or low exposure prevalence in this study,' they added. SOURCE: This study was led by Pallavi Nagdeve, MPH, and Russell Griffin, PhD, of the University of Alabama in Birmingham, Alabama. It was published online on July 24, 2025, in JAMA Ophthalmology. LIMITATIONS: The use of standard diagnostic codes may have led to misclassification of other optic neuropathy cases as NAION. Information available from the database used in this study was limited, and the reported associations may have been biased by unknown factors. DISCLOSURES: This study did not report any source of funding. The authors reported having no relevant financial conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
08-07-2025
- Business
- Medscape
Study Finds Wide Pay Gaps in Eye Care
Commercial insurance payments for common ophthalmology procedures vary widely across the US, with facility fees showing far greater variability than professional fees, a new study showed. The findings come from an analysis of January 2025 Transparency in Coverage data from four major insurers — Blue Cross Blue Shield, UnitedHealthcare, Cigna, and Aetna — and highlight the inconsistent nature of pricing in eye care. 'Facility prices are negotiated by hospitals, health-system outpatient departments, and large ambulatory surgery centers that wield substantially more market clout than individual ophthalmologists,' said Alexander P. Philips of the Center for Advancing Health Policy Through Research at the Brown University School of Public Health in Providence, Rhode Island. 'Those institutions fold a wide range of fixed costs — real estate, equipment, around-the-clock staffing, and community-benefit obligations — into their rates, so the starting point for negotiation differs dramatically from one organization to the next.' Philips and Christopher Whaley, PhD, also of the Center for Advancing Health Policy Through Research at Brown University School of Public Health, published their findings on July 3 in JAMA Ophthalmology . For the analysis, Philips and Whaley looked at more than 740,000 price points for 10 high-volume ophthalmology procedures such as intravitreal injections, iris revision surgery, treatment for severe retinopathy, and laser surgery for postcataract treatment. They found facility fees paid by insurance companies often exceeded professional charges by factors of two to four. For example, median facility prices for standard cataract surgery ranged from $1521 (Cigna) to $4274 (Aetna), a spread of $2753. In contrast, professional fees for the same procedure showed a much narrower interquartile spread of just $439, from $581 to $1020. 'What a physician can charge is anchored to well-known relative-value schedules that leave less room for maneuver,' Philips said. 'The moment a hospital acquires a previously independent office, the exact same cataract extraction can suddenly carry a separate facility component, widening the gap even further.' For patients, the result can be unpredictable out-of-pocket costs that can skyrocket depending on where they undergo the procedure. 'Independent clinicians, meanwhile, find it harder to compete, and insurers ultimately load those higher facility payments into premiums,' Philips said. Blue Cross Blue Shield consistently paid above-market rates, 14% higher for professional fees and 13% higher for facility fees, whereas Aetna showed the most dramatic divergence, with professional fees 54% below average and facility fees 45% above, the researchers found. 'Aetna appears to drive a hard bargain with individual physicians, who usually have limited leverage, while conceding more to large hospital systems that control valuable operating rooms and imaging equipment,' Philips told Medscape Medical News . 'That strategy allows the plan to advertise a lean physician fee schedule to employers, keeping the most visible line item in check, yet still maintain broad hospital networks by paying the premiums those systems demand on the facility side.' 'This pattern can look different across specialties; insurers often deploy distinct, specialty-specific tactics depending on whether hospitals, physician groups, or ancillary providers hold the upper hand,' he added. 'For example, UnitedHealth Group's deep vertical integration through Optum gives it the leverage to align professional and facility payments within its own physician and ambulatory-surgery platform, which produces a negotiation dynamic unlike what we see with Aetna in ophthalmology.' Geographic Analysis The study's geographic analysis revealed up to fivefold differences in median facility prices for cataract surgery across states. Outlier states like Connecticut and Alaska had significantly higher prices, potentially due to academic centers or Medicare payment policies, the researchers reported. Philips and Whaley suggest market dynamics such as insurer-provider negotiations, selective contracting, and vertical integration play a major role in shaping these disparities. For instance, UnitedHealthcare's lower facility fees may reflect its ownership of care delivery assets through Optum, while Cigna's lower prices suggest a strategy of selective contracting with providers willing to accept lower reimbursement in exchange for volume. The commentary also highlighted the potential of publicly available, insurer-posted data on negotiated prices to empower smaller practices. 'Transparent prices can empower smaller groups or solo practitioners with data for fair negotiations,' the authors wrote. 'Facility revenue can be indirectly critical for ophthalmologists in large departments.' Still, both the study and commentary stress price alone is not a proxy for value. 'These prices are administrative constructs and may not reflect patient responsibility or the actual cost of care delivery,' the commentary noted. 'Patients should resist the reflex to equate a higher bill with better care. What matters far more is choosing the right setting: The same surgeon can perform a cataract extraction in a physician-owned ASC [ambulatory surgery center] for half of what it would cost in a hospital outpatient department, with no difference in clinical outcome,' Philips said. 'That said, both clinicians and patients have limited leverage to shift markets on their own; real progress depends on policy interventions that rein in unwarranted price dispersion across the system. Awareness helps individuals avoid the worst surprises, but meaningful change will flow from site-neutral payment reforms, tighter antitrust oversight, and transparency rules that expose and discourage outlier prices.' Transparency Reforms In an invited commentary, Sean T. Berkowitz, MD, MBA, of the Department of Ophthalmology at Vanderbilt University Medical Center in Nashville, Tennessee, and his coauthors from Cleveland Clinic, Cleveland, emphasized that ophthalmology is uniquely positioned to benefit from transparency reforms due to its high volume of standardized procedures. However, they cautioned the data may not fully capture the nuances of care delivery. 'Site of service may impact findings,' they wrote. 'The proportion of hospital or ambulatory surgical centers in each network or geographic area may explain the larger variation in facility fees.' They also warned that increased transparency could have unintended consequences. 'More data on local price variation may incentivize upward price pressure, consolidation, and vertical integration,' according to the authors of the commentary. 'Transparency must be paired with policies that promote competition and protect access.' The authors of the paper and commentary reported no relevant financial conflicts of interest.
India Today
08-06-2025
- Health
- India Today
Weight loss drugs can double risk of eye disease: Study
Weight loss drugs can double risk of eye disease: Study Credit: Getty Images Weight loss drugs could double the risk of getting eye diseases, a large-scale study has found. The weight loss drugs that belong to the glucagon-like peptide-1 receptor agonist (GLP-1 RA) can increase the risk of getting age-related eye disease. This eye disease, known as macular degeneration, affects the central vision, primarily impacting older adults with diabetes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are medicines that help the body lower blood sugar levels. They work like a natural hormone called GLP-1, which tells the body to release insulin after eating. What are GLP-1 drugs? These drugs are often used to treat type 2 diabetes and sometimes help with weight loss too. Academics at the University of Toronto examined medical data from more than 1 million Ontario students with diabetes. Nearly all of them were taking semaglutide, a popular diabetes and weight loss drug. The study found that those taking semaglutide for at least six months had twice the risk of developing macular degeneration. As per the study, published in JAMA Ophthalmology, diabetic patients who were older and had an even higher risk of developing macular degeneration. "Based on our data, I would advise exercising particular caution when prescribing GLP-1 RAs to older [diabetic] patients or those with a history of stroke," said Marko Popovic, a co-author of the study.
Health Line
07-06-2025
- Health
- Health Line
GLP-1 Drugs Linked to Age-Related Macular Degeneration, Study Finds
GLP-1 drugs are associated with a higher risk of 'wet' age-related macular degeneration in people with type 2 diabetes, according to a new study. Researchers found that the risk substantially increased the longer people were prescribed a GLP-1 drug, particularly those containing semaglutide. GLP-1 medications like Ozempic and Wegovy have surged in popularity as weight loss treatments, but ophthalmologists say their potential risks to eye health are not well understood. GLP-1 drugs are linked to a significantly higher risk of developing neovascular or 'wet' age-related macular degeneration, according to new research. The study, conducted by researchers at the University of Toronto, found that people with type 2 diabetes who were prescribed GLP-1s were more than twice as likely to develop wet AMD as those who weren't. The study also found that the longer subjects were treated with these medications, the greater their risk of developing wet AMD. Neovascular age-related macular degeneration, commonly known as wet AMD, is the less common but more aggressive form of age-related macular degeneration, and a leading cause of irreversible vision loss among older adults in the United States. The findings, published on June 5 in JAMA Ophthalmology, suggest that doctors and patients should be aware of the potential risks, even though the chance of developing the condition remains relatively low. GLP-1 drugs, a class of blockbuster diabetes and obesity drugs sold under brand names like Ozempic and Wegovy, have surged in popularity in recent years. They offer a range of substantial benefits, including weight loss, improved blood sugar levels, and reduced cardiovascular disease risk. Despite these benefits, ophthalmologists say the impact of GLP-1 drugs on eye health is not well understood. Studies have identified an association between the medications and other eye conditions, including diabetic retinopathy and non-arteritic anterior ischemic optic neuropathy (NAION). While the findings don't establish a clear causal link between GLP-1 drugs and eye disease, experts say there's still reason for caution. 'The dose-response effect we observed — where longer GLP-1 receptor agonist exposure was associated with higher risk — strengthens the argument that this association may reflect a true biological effect rather than being due to confounding factors,' said study co-author Andrew Mihalache, MD(C), of the Temerty Faculty of Medicine at the University of Toronto, Canada. 'Seeing a graded relationship like this suggests that prolonged exposure could play a causal role in increasing risk. However, this needs to be confirmed in future studies,' he told Healthline. Long-term GLP-1 drug use may triple wet AMD risk Drawing on health records from Ontario, Canada, researchers at the University of Toronto analyzed nearly 140,000 adults with type 2 diabetes to investigate a possible link between GLP-1 use and wet AMD. The retrospective study tracked patient outcomes over a three-year period, using data collected between 2020 and 2023. Roughly one-third of participants — about 46,000 people — had been prescribed a GLP-1 drug for at least six months. The rest had not. In the vast majority of cases (97.5%), that drug was semaglutide, the active ingredient in Ozempic and Wegovy. The average participant was 66, and the cohort was almost evenly divided by sex, with females representing 46.6% of the group. On average, those who were prescribed a GLP-1 drug were more than twice as likely to be diagnosed with wet AMD. However, that number doesn't tell the full story. People who took GLP-1 drugs for longer experienced progressively greater risk. Those who had only taken their medication for 6–18 months actually had a slightly lower risk than those who didn't take the medication. However, at the 18–30 month mark, GLP-1 users' risk of developing wet AMD more than doubled compared to non-users. And those taking the drugs for 30 months or longer had more than triple the risk. 'This was definitely surprising, especially given the growing enthusiasm for GLP-1 receptor agonists for their cardiovascular and metabolic benefits. It really highlights the need for further investigation into their ocular safety profile,' first study author Reut Shor, MD, of the Department of Ophthalmology and Vision Sciences at the University of Toronto, Canada, told Healthline. Despite the increase in risk, the absolute risk of developing wet AMD was still low: 0.2% among those taking a GLP-1 and 0.1% among those who didn't. Do GLP-1 drugs harm eye health? While not definitive, the study raises further questions about the potential risks posed by GLP-1 drugs for eye health. Prior studies have also identified links between GLP-1s and other forms of eye disease in people with type 2 diabetes. In a major phase 3 semaglutide trial in 2016, researchers identified that type 2 diabetes patients taking semaglutide had a higher risk of complications of diabetic retinopathy compared to a placebo. Those findings were published in The New England Journal of Medicine. However, other studies have provided conflicting evidence. A retrospective 2024 study evaluated nearly 700 subjects with type 2 diabetes who were taking a GLP-1 drug and found no association between GLP-1s and worsening retinopathy. Also in 2024, researchers found that patients with type 2 diabetes who were prescribed semaglutide were at greater risk of NAION compared to those who weren't. NAION is a condition that causes sudden blindness, typically just in one eye, due to a lack of blood flow to the optic nerve. The mechanism for why GLP-1 drug use may lead to wet AMD is not well established, but a predominant theory is that lowering blood sugar rapidly leads to a lack of oxygen in the retina. 'When you make the retina more hypoxic, which is what the GLP-1s do, it basically pushes it further over the threshold, causing more abnormal blood vessels to grow,' said Linda Lam, MD, MBA, an ophthalmologist with Keck Medicine of USC, who wasn't involved in the research. Abnormal blood vessel growth in the eye is the hallmark of wet AMD. While GLP-1s offer many health benefits, eye disease risk must be considered in some populations, Lam told Healthline. 'In this particular group of patients who are older, who are diabetics, I really would caution against the extended use of GLP-1s,' she said. Lam reiterated the importance of annual eye exams for the general population, but in particular for those with diabetes, to identify and diagnose eye disease early on. People with type 2 diabetes, especially those taking a GLP-1 drug, should be aware of the signs and symptoms of vision loss and consult with their doctor immediately. These include:
New York Post
06-06-2025
- Health
- New York Post
Ozempic makes you twice as likely to develop this debilitating condition — what that really means for your risk
A growing number of Ozempic and Mounjaro users have shared stark warnings after going blind while using GLP-1 drugs. Now a new study is bringing into focus the relationship between diabetic GLP-1 users and the elevated risk of age-related eye disease. But despite seemingly alarming numbers, a doctor explained to The Post why she doesn't actually think it should steer people away from the jab. 3 A 2024 study found that 12% of the US population has taken a GLP-1 drug at some point, with around 6% currently using them. alones – Published in JAMA Ophthalmology, the study was drawn from the health records of nearly 140,000 patients. Researchers found that after one year, GLP-1 users were more than twice as likely to develop neovascular age-related macular degeneration than those who were not taking the drugs. Age-related macular degeneration (AMD) is a disease that gradually damages the macula, the part of your eye's retina responsible for sharp, central vision. As it worsens, people find it increasingly difficult to see things directly in front of them, while their peripheral vision remains largely unaffected. In older people, AMD is a leading cause of irreversible blindness. The study found the risk percentage was 0.2% in GLP-1 users and 0.1% in nonusers. Nearly 20 million adults in the US are living with AMD, which comes in two types. The slower-moving dry AMD makes up about 80% of cases. It occurs when the macula gets thinner with age, often due to the buildup of yellow protein deposits known as drusen, according to the American Academy of Ophthalmology. Wet AMD, also known as neovascular AMD (nAMD), while less common, is far more aggressive, causing rapid and severe vision loss. In this form, the macula's function is compromised by the growth and leakage of abnormal blood vessels beneath the retina. The condition is typically treated with frequent injections to restore or stabilize vision. 3 Kaden notes that while there is cause for concern, headlines will amplify what she believes is a relatively low risk Northwell Foundation 'What researchers in this latest study were looking for specifically was whether or not these were people who converted from the dry form of macular degeneration, which is where you don't have abnormal blood vessels to the wet form, which is when you do,' Dr. Talia Kaden, director of the Northwell Health retina fellowship told the Post. But Kaden noted that while there is cause for concern, she actually believes there a relatively low risk. 'We're talking about a handful of patients who might have an increase in retinopathy compared to the millions of patients on these medications.' Dr. Talia Kaden 'That 2X number is really powerful, but when you look at the raw data, I don't think it's quite as strong a punch. I don't think that number should be a reason for people not to be on these drugs. I do think, though, it is worth continuing to look into,' she said. This study adds to a growing body of research documenting vision problems in patients using GLP-1 drugs. A review published earlier this year in JAMA Ophthalmology uncovered at least nine cases of patients who experienced vision loss after taking semaglutide or tirzepatide, the active ingredients in Wegovy and Zepbound, respectively. And a 2024 study suggested a potential link between semaglutide and the rare eye condition nonarteritic anterior ischemic optic neuropathy (NAION), in which restricted blood flow to the optic nerve causes sudden-onset vision loss. 'None of these studies are definitive in identifying that there has been a change. Some of them show a slight increase, but we're talking about a handful of patients who might have an increase in retinopathy compared to the millions of patients on these medications,' Kaden said. 3 In older people, AMD is a leading cause of irreversible blindness. StockPhotoPro – Researchers think that declining blood glucose levels caused by GLP-1s could trigger abnormal blood vessel growth in the retina. Further, there are GLP-1 receptors in the retina, and these drugs increase the levels of molecules that lead to harmful blood vessel formation. 'Seeing such a clear signal in our study was striking,' co-author Reut Shor of the University of Toronto told STAT. 'The absolute risk remains low, but the advanced form of AMD is a condition with serious implications for vision and quality of life. So a doubling of risk is clinically meaningful, particularly for vulnerable populations like older adults who may already be at elevated baseline risk.' Shor and his team note that more research is necessary to determine whether direct or indirect effects are causing the increased risk of nAMD. Shor and Kaden maintain that these findings should not be cause for alarm nor a reason to halt the prescription or use of these medications; rather, patients should be made aware of the risk and monitor their vision accordingly. Kaden, the study authors, and other experts recommend that GLP-1 users be on the lookout for any vision changes that could indicate early signs of AMD. 'We really want you to look for anything blurring, any new distortion. If you're looking at a flagpole or a doorframe, that should be a straight line. If all of a sudden that line looks wavy or curvy, that's a reason to seek a consultation with a retina specialist,' said Kaden.
