Pharmacologic treatments for presbyopia promise to give patients freedom and flexibility in the midst of busy careers and active lifestyles. They’re non-invasive, they’re adjustable, and they offer help in transitioning between near, intermediate, and distance vision. But patients miss the boat if optometrists don’t discuss it with them. Jacob Lang, OD, FAAO, called it out at CIME 2025 to Optometry Times:

Some of the barriers that patients run into with regards to pharmacologic correction and presbyopia … I think one of the biggest ones is their providers. It’s actually the doctors not knowing what options are out there with regards to pharmacologic correction and how those pharmacologic options might benefit their patients in their chairs. So furthering their education, embracing new things … I think that’s the biggest thing and the biggest barrier to patients getting access to these options.

Who are the best candidates?

Presbyopia drops tend to work best for patients who meet most of the following criteria:

• Early to moderate presbyopia, where near blur is present but not yet constant across all tasks
• Stable distance vision, whether emmetropic or well corrected with spectacles or contact lenses
• Patients seeking situational near-vision support for workdays, social events, or travel
• Post-refractive surgery patients who have good distance outcomes but are frustrated by the onset of presbyopia

Patients with significant cataracts, retinal pathology, or severe dry eye are not ideal candidates. Pupil size, while a factor, isn’t as critical as motivation and ocular health. Also at CIME 2025, Selina McGee, OD, FAAO, emphasized that it’s less about the perfect measurement and more about the patient’s willingness to try something new.

Drops can complement progressive lenses or monovision or multifocal contact lenses. And as bulleted above, they can support post-surgery patients or those seeking a temporary boost. McGee urged ODs to educate patients on combining options based on their lifestyle needs.

Here’s important context from Marc Bloomenstein, OD, FAAO, in his deep dive on presbyopia eye drops (which we recommend reading).

Presbyopia drops aim to restore near vision by targeting the size of the pupil and thus inducing an extended depth of focus. A very important and distinct feature to note is that we are not inducing accommodation; thus, there is not an enlargement of text on the page or screen, as you would experience wearing readers, for instance. When patients who have myopia look through a progressive lens or multifocal contact lens, they are magnifying the image. Presbyopia drops do not have the same magnifying effect and therefore, as with any new treatment, they have an adaptation curve. There is, and will be, an adaptive period that is needed to allow the visual system to align with these new modalities.

Available and emerging drops

Current options:

Vuity (pilocarpine 1.25%)

• The first FDA-approved presbyopia drop (2021)
• Works by inducing miosis to increase depth of field
• Uses a proprietary rapid pH-shifting mechanism (pHast) designed to enhance absorption
• Onset: ~15 minutes, duration: up to 6 hours
• Common side effects: Headache, brow ache, eye redness, and reduced night vision due to pupil constriction
• No ocular surface lubricant in the formulation, which might contribute to stinging or burning on instillation, especially in patients with dry eye
• See Vuity prescribing information

Qlosi (pilocarpine 0.4%)

• FDA-approved in 2023
• Also induces miosis via pilocarpine
• Lower pilocarpine concentration → fewer side effects (and slower onset but greater comfort on instillation)
• Onset: ~20–30 minutes, duration: up to 6 hours
• Soothing vehicle formulation helps support the ocular surface
• Ideal for those who experienced discomfort with higher concentrations
• See Qlosi prescribing information

Another CIME 2025 attendee, Neda Shamie, MD, pointed out, “This new drop is really a two-in-one solution. It provides the visual benefits of pilocarpine while also supporting the ocular surface, which is often compromised in this demographic.”

Vizz (aceclidine ophthalmic solution) 1.44%

• FDA-approved in August 2025
• Uses aceclidine, a pupil-selective cholinergic agent, to induce miosis and increase depth of field
• Designed to limit ciliary muscle stimulation compared with pilocarpine-based drops
• Dose: Once daily using two sequential drops per eye from a single-dose vial
• Onset: ~30 minutes, duration: up to 10 hours
• See Vizz prescribing information

Yuvezzi (carbachol 2.75% / brimonidine tartrate 0.1%)

• FDA-approved in January 2026
• Fixed-dose combination of a cholinergic agonist (carbachol) and an alpha-adrenergic agonist (brimonidine)
• Designed to induce miosis and increase depth of field while moderating some miotic-related effects through combination therapy
• Dose: Once daily
• Onset: ~30 minutes, duration: 8–10 hours
• See Yuvezzi prescribing information

Recommended read: For a deeper dive into clinical implications of currently available drops, including ophthalmologist commentary, check out Options for Presbyopia Treatment Continue to Evolve, Healio

In the pipeline:

Current development in the presbyopia pipeline are focused less on expanding the field and more on refining durability, tolerability, and delivery. Here’s a few notables:

• Nyxol (phentolamine 0.75%) uses a different mechanism — alpha blockers — to modulate pupil size, with Phase III data reporting significant near-vision improvement and extended duration
• Microdosed delivery systems (such as Eyenovia’s MicroLine) are in development, using established pharmacologic agents delivered in smaller, more precise volumes
• Lens-softening agents (including LX-OPH-162) are also under investigation, although earlier in development as a non-miotic approach

A note on barriers:

Many of these newer therapies still lack long-term efficacy data. What has also become more explicit in newer clinical commentary is that the category lives or dies on patient experience. That includes headache rates, dimming complaints, redness, and night driving concerns, especially because these drops are elective, cash-pay treatments.

On the provider side, we expect some will wait to see which brands rise to the top. That, combined with a desire to wait for post-market experience, will likely be the main factors slowing widespread use.

This content is intended for educational purposes only and does not substitute for clinical judgment. Treatment decisions should be based on individual patient needs, professional guidelines, and a comprehensive clinical evaluation.

The post A Practical Guide to Presbyopia Drops [UPDATED] appeared first on Optometry 411.

Each guideline listing includes the issuing organization and the date of the most recent update, so you can quickly gauge how current the information is before diving in — although an older date doesn’t mean it’s unhelpful. Regarding the glaucoma section, RO notes “many of the older reports will not reflect the current scientific literature, [but] you may nevertheless find them worthwhile to review, especially on topics such as anatomy and pathophysiology, which are less likely to become outdated by advances in technology.”

You’ll find linked resources from the American Optometric Association, American Academy of Ophthalmology, International Myopia Institute, Tear Film and Ocular Surface Society, World Glaucoma Association, and several international specialty societies.

RO notes that the index will continue to be updated as new guidelines are released, with plans to expand coverage as additional expert bodies publish recommendations. You can also share feedback if there are specific documents or sources you’d like to see added.

See the full directory here: Index of Clinical Guidelines for Optometrists

The post A New Way To Find Evidence-Based Optometric Guidelines appeared first on Optometry 411.

Of course, some night driving symptoms are due to underlying ocular or neural factors — IOL optics, corneal irregularity, retinal health, mesopic pupil behavior — that may not respond meaningfully to lens-based solutions. Even so, patients often look to their OD for guidance on what can realistically improve night driving comfort.

Today, Optometry 411 looks at the brands and categories worth knowing about as you help patients navigate the lens-based options available.

ZEISS DriveSafe

ZEISS DriveSafe is one of the more established driving-specific lens designs and a common reference point for ODs, and it is sometimes presented as an everyday lens with driving benefits rather than a dedicated night-driving pair. It’s a clear lens paired with an AR coating tuned to reduce perceived glare from headlights, streetlights, and reflective road surfaces.

Hoya EnRoute 

Hoya’s EnRoute family takes a tiered approach. The standard EnRoute lens is designed for low-light clarity and comfort without adding a tint.

The EnRoute Pro version introduces a contrast filter that can be helpful in certain driving conditions, but because it reduces light transmission, it is better framed as a daytime or mixed-use solution. Being able to explain that distinction helps patients avoid choosing the Pro version for the wrong reason.

Shamir Driver Intelligence Moon lenses

Shamir Driver Intelligence Moon is a newer entry in the category of clear, optics-based lenses designed specifically for night driving. The lens is developed using data-driven optical modeling, including AI-based analysis during the design process. Development was in collaboration with the BWT Alpine F1 Team, which makes for an interesting talking point.

Premium AR lenses that aren’t specifically for driving

Some ODs prefer to stick with high-quality AR stacks rather than specialty driving designs. These aren’t night lenses per se, but they do aim to cut down on ghosting, halos, and distracting reflections that become more noticeable after dark.

A few that come up often:

ZEISS DuraVision Platinum
Essilor Crizal Sapphire HR
Hoya Hi-Vision LongLife AR
Nikon SeeCoat Bright

These could appeal to patients who want durability and all-day performance, with improved nighttime comfort as a secondary benefit rather than a primary feature.

Yellow or amber “night driving glasses” 

Yellow-tinted glasses are probably the most heavily marketed night driving products in the consumer space. A quick search on Reddit, for example, shows users overwhelmingly suggesting yellow-tinted lenses to each other, usually to combat the aforementioned glare from bright headlights in oncoming traffic. A few name brands beyond the multitude of generic online options: Rx-Safety Halo, Eagle Eyes, NoIR, Night Rider.

The key point to emphasize here is that these tints reduce overall light transmission. Most wearers don’t consciously register the loss of ambient light. What they do notice is softer headlights. Openly acknowledging this distinction/tradeoff in your patient conversations is a good idea.

Where yellow tints are most defensible:

• Well-lit urban driving
• Dusk or early evening conditions
• Patients whose primary complaint is discomfort rather than object detection

Where they are least appropriate:

• Rural or poorly lit roads
• Older patients with reduced contrast sensitivity

Clip-ons and fitovers

As with yellow-lens glasses, clip-ons and fitovers are widely available and inexpensive, but again, they aren’t the strongest overall performers for nighttime vision because of the tint. Brands patients might mention include Cocoons, Solar Shield, Fitover USA.

Zenni NeoContrast

We’re mentioning NeoContrast lenses separately because they appear nearly clear. They use a mild contrast-enhancing filter rather than a heavy tint, which is why they present differently than the saturated yellow we’ve come to expect. That said, even mild spectral filtering reduces overall light transmission to some degree, so it’s worth a conversation about the tradeoffs.

Recommended read: Optometry Times has insights on identifying nighttime visibility difficulty

Photochromic options, with important nuances

Photochromic lenses frequently come up in conversations about driving, but they are not designed to improve nighttime vision. Some newer options do activate behind the windshield, which can be helpful for daytime or dusk driving. Examples include Transitions XTRActive and Hoya Sensity Dark, both of which provide behind-the-windshield activation and deeper tinting in bright conditions. Transitions Drivewear is polarized and optimized specifically for daytime driving.

These lenses can be useful for commuters who drive in changing light, but they should not be positioned as solutions for nighttime glare or low-light visibility.

Non-optical factors

An important aside: Vehicle-related factors can also contribute to glare and reduced visibility. Might be worth mentioning to patients that cleaning the inside and outside of their windshield regularly can make a noticeable difference. Dim the interior/dash lights as much as possible. Fresh wiper blades can help, too.

The post Options To Explore for Patients Struggling With Night Driving appeared first on Optometry 411.

The idea that the eye offers clues to overall health isn’t new, but oculomics makes it measurable, using high-resolution ocular imaging and AI to detect biomarkers of cardiovascular, renal, metabolic, and even neurologic disease long before overt signs appear.

A June 2025 article in The Ophthalmologist noted that since the term “oculomics” was coined in 2020, more than 400 papers have been published. That momentum suggests optometry is poised to play a much larger role in systemic health.

Here are a few key developments from this year that are especially relevant for ODs to keep tabs on.

1. AI-enhanced retinal imaging as biomarkers for systemic disease

A major review published in early 2025 showed that AI-driven analysis of retinal images (color fundus, OCT, OCT-A) is now reliably linked to predicting a broad range of systemic diseases: cardiovascular, renal, metabolic and neurologic.

One real-world study applied radiomic features from multimodal retinal images to a cohort of type 1 diabetics and achieved near-perfect accuracy in predicting cardiovascular risk, especially when OCT and OCT-A data were included.

Other research has shown that AI can also estimate systemic risk factors such as smoking status, age, and blood pressure directly from fundus images, often with remarkable accuracy, which strengthens the case for oculomics’ potential to detect disease risk even before clinical signs appear.

Caveat: Image quality, algorithm bias, and generalizability remain concerns. As you know, AI is only as good as the data it is trained on. To prepare for future integration, focus on capturing excellent image quality and consistent documentation (for example, vessel calibre, tortuosity, and capillary density in OCT-A). These are the metrics researchers are currently feeding into AI models.

Related read: A New, Great Indicator (Review of Optometry)

2. Multi-modal imaging & foundation models

Recent research is moving beyond single-image analysis toward foundation models that learn from multiple imaging types — fundus, OCT, and OCT-A — at once. These large-scale AI systems are designed to detect subtle patterns linked to systemic conditions like hypertension and diabetes. A mid-2025 study introducing FusionFM showed that combining data from multiple test types improved prediction accuracy and held up across different patient populations.

As imaging technology becomes more integrated, the value of consistent, high-quality scans only continues to grow.

3. Opt-in data sharing

Device makers are laying the groundwork for the next step in clinical use: voluntary data-sharing networks. Platform vendors like Topcon (Harmony) and ZEISS (Research Data Platform) are developing AI-enabled data-management systems that enable clinics and researchers to securely aggregate imaging data for AI development.

Participation is generally opt-in and governed by explicit consent and de-identification protocols. In other words, your imaging data doesn’t leave your practice or get used for model training unless you choose to enroll. But be sure you understand each vendor’s policies in advance.

4. Retinal microvasculature and neurodegenerative disease

New findings reinforce that alterations in retinal nerve fiber layer (RNFL) thickness, ganglion cell layer integrity, and capillary density (via OCT-A) correlate with risk for neurodegenerative conditions such as Alzheimer’s and Parkinson’s disease.

The 2025 meta-analysis “The Eye as a Window to Systemic Health” reaffirmed that the retina gives noninvasive access to neural tissue and vasculature, making it a candidate for early brain disease screening.

Thoughts for the forward-thinking OD

Even though research is robust, cost-effectiveness, reimbursement, and regulations are still evolving. But there are ways to prepare your practice in the meantime.

• As mentioned up top, optimize your imaging protocols to produce high-quality, repeatable scans and link the data to your patient records in a way that allows tracking. This will improve your data quality and make it easier to adopt new technologies as they become available.
• Record patient demographics and deviations from normative OCT/OCT-A data (even in asymptomatic patients) so you’ll be able to identify subtle changes over time.
• Build relationships with cardiology, nephrology, and neurology providers so that when you identify concerns, you have a referral network.
• Be on the lookout for developments. As AI/oculomics advances, new imaging tools and software will likely make systemic risk assessment easier to incorporate into your practice.

The post Top Oculomics Breakthroughs in 2025: What They Mean for Optometry appeared first on Optometry 411.

Every year, new data trickles in about what optometrists are doing, earning, prescribing, and pushing for, and it’s easy to lose sight of where you stand in the mix. Consider this a quick tour through the latest benchmarks.

OCT-A adoption

According to the 2025 Retina Report from Eyes on Eyecare, 27.79% of 403 surveyed ODs said their practice doesn’t have OCT-A, meaning roughly 7 in 10 do. Among users, Zeiss Cirrus and Heidelberg Spectralis were commonly cited in the survey’s brand list. Source: 2025 Retina Report

Pediatric myopia management

About 7 in 10 U.S. providers now offer it. 91% of providers are recommending annual screening, and MiSight has been the most commonly prescribed option. Biggest hurdles are cost (86%), parent understanding (56%), and adherence (49%). Source: The Vision Council

Global trend: Among children ages 6 – 12, soft myopia-control lenses accounted for ~30% of all contact lens fits in 2024, and orthokeratology comprised ~87% of rigid lens fits in this age group. The U.S. is lagging behind this international growth.

Contact lens prescribing

We’re still awaiting 2025 wrap data, but Contact Lens Spectrum’s 2024 market wrap shows dailies still on top. Close to half of U.S. soft lens fits were daily disposables last year. Within that, daily SiHy lenses hit about 41% of the daily category and are expected to cross the 50% mark soon. If your daily/SCL mix isn’t trending upward, you may be behind the curve.

Rigid lenses are still a smaller slice of U.S. prescribing, about 10% of all fits. Within that rigid category, sclerals keep gaining: 27% of fitters say sclerals now make up more than half of their GP fits (up from 22% in 2024 and 13% in 2023). Ortho-k is inching up: 48% of respondents reported their overnight ortho-k fitting increased over the past 12 months.
Source: GP and Custom Soft Annual Report 2025

Scope & procedures

As of right now, 14 states authorize optometric laser procedures, following new laws in Montana (effective July 1, 2025) and West Virginia (effective July 9, 2025).

A 2024 safety review covering 146,403 OD-performed laser procedures across authorized states found just two complications (roughly 0.001%). This data point continues to be widely cited in 2025 legislative and policy debates.

Payers & access

ODs almost never opt out of Medicare. From 2005 – 2023, only 0.38% of optometrists formally opted out, meaning participation is nearly universal. Access issues are more about clinic capacity than program drop-outs. Source: Opting out of Medicare: Characteristics and differences between optometrists and ophthalmologists

By comparison, about 1.2% of non-pediatric physicians opted out in 2024. Eye care is stickier than average.

Workforce snapshot

In 2024, there were about 47,800 optometrist jobs in the U.S., and the Bureau of Labor Statistics projects 8% growth through 2034.

Women now make up just over half of practicing ODs. Review of Optometry, citing AOA workforce data, put the figure at 50 – 53% in 2024, confirming that parity has tipped. And the pipeline is decidedly shifting. In the 2024 – 25 academic year, 70.8% of full-time OD students were women.

Where people work (private, corporate, PE)

In just seven years (from 2017 to 2024) private practice’s share of the optometric workforce fell from 51% to 41%. Over that same span, corporate roles rose from 20% to 24.7%, and private equity–backed offices grew from 3% to 10.9%. Source: Culture Shift: The Changing Career Prospects and Priorities of Today’s OD

Pay

The national median income for optometrists was $134,830 in 2024.

A 2025 survey of 2,200 ODs reported an adjusted average of $136,619, with men earning about $177,700 and women about $153,800 — a 13.5% gender pay gap.

The 2025 Jobson Income Study showed similar results, with men averaging $190,167 compared to $163,255 for women.

Tracking where the profession stands today can help you push for better tomorrow in your clinic, your pay structure, and the policies you support. Benchmarks give you the data; the next step is what you do with it.

The post How Do You Stack Up? Benchmarks for US ODs appeared first on Optometry 411.

Optometry 411 keeps you in the loop with the latest:

When gut bacteria reach the retina

An interesting recent discovery comes from an animal study on CRB1 gene mutations, which are tied to certain retinal degenerations. Researchers found that these mutations can cause both a “leaky gut” and a “leaky retina,” allowing bacteria from the gut to migrate directly to the retina. The result is inflammation that accelerates retinal damage. While these findings are preliminary (and based on animal models), they align with broader research showing that a compromised mucosal barrier can trigger systemic inflammation that affects multiple organs, including ocular tissues.

Early interventions are promising, but preliminary

A 2023 systematic review identified 25 studies linking gut dysbiosis (microbial imbalance) to ocular disease, including uveitis, glaucoma, and in some cases chalazion. Dry eye may also be influenced by gut microbiota. Only a handful of trials have tested gut-targeted treatments — like probiotics or fecal transplants — and while results were encouraging, sample sizes were small. The consensus is that the concept is promising, but we’re far from mainstream clinical protocols.

Of course, research continues to expand the picture. Other recent findings: In glaucoma, particularly primary open-angle glaucoma, certain bacterial strains and their metabolites may influence immune pathways involved in disease progression. In AMD, gut microbial profiles differ between those with advanced disease and healthy controls, suggesting a role in both inflammation and oxidative stress regulation.

In diabetic retinal disease, gut imbalance can increase intestinal permeability, allowing inflammatory molecules into circulation, which in turn can worsen retinal damage. Even retinal artery occlusion has been linked to gut changes, possibly through the same risk factors that drive vascular disease, like atherosclerosis and certain gut-derived metabolites. (source)

Systemic health links

Recent work connects the gut–eye axis to cardiovascular health. Gut microbiome imbalances may contribute to hypertension, which is a known risk factor for vision loss. Researchers are exploring whether improving gut health through diet, prebiotics, or probiotics could provide a dual benefit for vascular and ocular health.

Nutrition as a bridge between gut and eye care

For ODs looking to give patients actionable advice today, diet may be the most accessible lever. A randomized controlled trial published in The Journal of Nutrition found that eating two handfuls of pistachios daily for 12 weeks improved macular pigment optical density, likely due to lutein content, while also supporting cardiovascular and gut health.

Similarly, leafy greens like spinach and kale provide both prebiotics that feed beneficial gut bacteria and antioxidants that support retinal health. Diets high in fat and sugar have been associated with gut dysbiosis, while fiber-rich diets promote short-chain fatty acid production with anti-inflammatory benefits. 

Bottom line: We’re just beginning to understand which microbes matter most, how they influence ocular tissues, and which interventions will make the biggest difference. As they say, watch this space.

Additional resources for further reading:
From Gut to Eye: Exploring the Role of Microbiome Imbalance in Ocular Diseases
The Gut Microbiome Affects Eye Disease, And May Open New Therapy Options
Gut Microbiota and Eye Diseases: A Review

This article is intended for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Clinicians should consult current research and clinical guidelines before applying any concepts in practice, and patients should always seek personalized advice from their healthcare provider.

The post The Gut–Eye Connection: What’s New for ODs To Know appeared first on Optometry 411.

At Optometry 411, we’re taking it a step further to help you get something sustainable going. Understanding the “what” is only half the battle. The implementation is where things can get tricky.

Below, we unpack the essentials and explore which steps tend to be the biggest hurdle for most practices.

In terms of the required relationships, Dr. Curtis emphasizes that meaningful connections are the bedrock of integrated care. But you need to do more than exchange contact info. The best collaboration stems from mutual respect and regular engagement. How can you build that respect?

Action items:

• Personally reach out to local providers after co-managing a patient.
• Attend CE events to meet colleagues from other disciplines.
• Join your local AOA affiliate and stay active.

Next, communicating how your findings impact the patient’s broader care plan is a vital part of of co-managed care and integrated care models. Take diabetic retinopathy, for example — alerting a patient’s PCP could influence how they manage blood sugar or adjust medications.

Action items:

• Use a standardized summary sheet or EMR template to share relevant findings.
• Ask providers how they prefer to receive updates (email, EHR message, etc.).
• Keep communication focused by highlighting only the findings that inform the next steps in care.

To really succeed here, you need to recognize that this type of communication/collaboration might not be one-size-fits-all. Some specialists will want comprehensive notes; others will just need a heads up. A cardiologist may not change management based on amiodarone-related keratopathy, but still appreciates the info.

Action items:

• Ask your local referral partners what’s helpful for them.
• Maybe even create a quick-reference list of preferred contacts and their communication style.
• Encourage feedback about what worked, what didn’t, what could be better.

Coordination is the most difficult but the most crucial.

This is where things often fall apart. Coordinating referrals, lab work, follow-ups, and specialist care, especially across health systems, can be a logistical nightmare.

Different systems may not share EHRs; patients may be unsure how to follow up; small practices may not have dedicated care coordinators, so you need to be prepared to anticipate pain points and smooth the process where possible.

Action items:

• Identify key referral hubs in your area and build relationships with them.
• Train staff to understand referral procedures, insurance barriers, and follow-up timelines.
• Keep a shared spreadsheet or digital database of go-to specialists with their contact info, turnaround times, and insurance accepted.

Let’s hone in on the “train staff” bullet point. Knowing who to call and how to reach them is half the battle. But equally important is having a trained team who knows how to navigate referrals, request records, and explain next steps to patients. How can you begin to create this for your team?

Action items:

• Build a referral cheat sheet with up-to-date info (contacts, hours, insurances).
• Regularly review the list with your team to keep it current.
• Consider role-playing scenarios so your team feels confident explaining why a referral matters or how to prepare for it.

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The post Integrated Care Is the Goal — Here’s What’s Getting in the Way appeared first on Optometry 411.

If you’ve been following closely, there’s been quite a bit of debate and investigation around just how significant and prevalent the ocular risks of GLP-1RAs truly are.

The American Optometric Association’s June 2025 clinical report feels like a welcome consensus. It offers timely, evidence-based guidance to help you manage these evolving risks in clinical practice. Optometry 411 brings you a quick overview of the findings. Let’s dive in.

At a glance: AOA-flagged ocular risks

NAION (Non-Arteritic Anterior Ischemic Optic Neuropathy)

• Identified as a very rare but serious risk associated with semaglutide, the most prescribed GLP-1RA (Ozempic, Wegovy, Rybelsus)
• Up to 2× increased risk with semaglutide use 
• After conducting risk assessment, the European Medicines Agency (EMA) calls for updated product info to list NAION as a very rare side effect
• Signs: Sudden, painless unilateral vision loss, visual field defect, dyschromatopsia, and optic disc swelling
• Discontinue GLP‑1RA and refer immediately if NAION is suspected

Diabetic retinopathy (DR) progression

• In the SUSTAIN-6 trial, semaglutide users showed a higher rate of DR complications (3.0%) than placebo (1.8%)
• This may result from rapid HbA1c reduction, a known contributor to early DR worsening
• Especially concerning in patients with preexisting DR
• Perform a baseline dilated eye exam and follow up within 12–18 months of treatment initiation

Neovascular AMD

• A population-based study found GLP-1RA users had a 2× higher relative risk of developing wet AMD (0.2% vs 0.1%)
• Though absolute risk remains low, the potential impact is vision-threatening
• Closely monitor individuals with AMD risk factors or history

Other rare events

Isolated reports of:

• Uveitis
• Diplopia
• Optic neuropathies beyond NAION

These are not yet confirmed by large-scale trials but suggest the need for comprehensive baseline evaluations. Maintain a high index of suspicion and educate patients to report new symptoms.

AOA Clinical Guidance for ODs

With GLP-1RA use increasing (15 million users as of 2024) and ophthalmology workforce shortages projected by 2035, ODs are primed to lead ocular monitoring in this area. 

As Invision reports: “There is a low risk of [serious ocular side effects],” says co-author Andrew Morgenstern, OD, director of the AOA’s clinical resources group. “But a low risk of a big number is a big risk. If it happens to you, it’s a problem.”

Read the full AOA report here: Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) and Ocular Health: Guidance for Optometric Practice

This content is intended for educational purposes only and does not substitute for clinical judgment. Treatment decisions should be based on individual patient needs, professional guidelines, and a comprehensive clinical evaluation.

The post AOA Releases New GLP-1RA Report: What ODs Need To Know About Vision Risks appeared first on Optometry 411.

For ODs, precise and empathetic documentation is a must. Optometry 411 outlines some key areas to watch for, along with simple questions you can ask yourself to make sure you’re on the right track:

Recognize stigmatizing language in optometric practice

Consider the following documentation examples:
“Patient is noncompliant with contact lens hygiene.”
“Patient claims to experience visual disturbances.”

These kinds of phrases may carry unintended negative connotations. Describing a patient as “noncompliant” can imply willful negligence, while “claims” may suggest doubt about the patient’s symptoms.

Using this language can ultimately affect how you and other clinicians perceive and manage the patient’s care.

Strategies for respectful and effective documentation

By now, you’re well aware of the value of using person-first language, i.e., “patient with glaucoma” instead of “glaucoma patient.” Using person-first language in documentation originated from disability rights advocacy in the late ’80s and has since been widely supported across healthcare orgs.

It’s also important to keep your notes objective and to avoid implying doubt. Let’s go back to the examples up top:

“Patient is noncompliant with contact lens hygiene.”
“Patient claims to experience visual disturbances.”

You might replace “noncompliant” with “patient reports challenges adhering to contact lens hygiene regimen.” And rather than “patient claims,” use “patient reports” or “patient describes.”

Terms like “difficult patient” should be avoided. You want to focus on specific behaviors or concerns.

Impact of language on patient care

We don’t bring all this up to be warm and fuzzy. A study published in JAMA Network Open found that negative — often not even explicitly negative — language in medical records can transmit bias and affect the quality of care that patients subsequently receive.

Self-Check Questions for Better Documentation

Am I describing the patient, or labeling them?

Is my language objective and factual?

Am I documenting observations without implying judgment? (“Patient reports not wearing lenses nightly” vs. “patient is noncompliant.”)

Would I be comfortable reading these notes aloud to the patient?

Have I noted barriers to care rather than implying blame?

Instead of “patient refuses treatment,” consider “patient declined treatment due to cost concerns.”

Am I considering cultural, socioeconomic, or personal factors in my documentation?

Does my note reflect an understanding of factors that may impact adherence or behavior?

Is my documentation supporting continuity of care?

Will another provider reading this note gain a clear, unbiased view of the patient’s condition and concerns?

Am I using language that promotes patient-centered care?

Does this note reflect partnership and collaboration with the patient, or does it create an us vs. them dynamic?

The post Ask Yourself These Questions for Better Patient Documentation in Optometry appeared first on Optometry 411.

The International Clinical Diabetic Retinopathy (ICDR) Severity Scale was created to refine DR classification in efforts to improve diagnosis and management:

• Mild NPDR: Microaneurysms only → Annual monitoring.
• Moderate NPDR: Intraretinal hemorrhages present → 9- to 12-month follow-up.
• Severe NPDR: Based on the 4-2-1 rule (four quadrants of hemorrhaging, two quadrants of venous beading, one quadrant of IRMA) → Referral to retina specialist recommended.
• PDR: Presence of neovascularization → Urgent referral for anti-VEGF therapy and/or panretinal photocoagulation (PRP).
• DME: Referral recommended for center-involved (CI-DME) cases, particularly those affecting best-corrected visual acuity (BCVA).

During “Current Strategies on Managing Diabetic Eye Disease,” a session at the recent Vision Expo East, Mary Beth Yackey, OD, and Jessica Haynes, OD, presented strategies for managing DR in your practice — tackling patient education, risk assessment, and treatment coordination for your diabetic patients. We’ll touch on a few of the guidelines shared:

• Type 1 Diabetes: The American Diabetes Association and AOA guidelines recommend a baseline eye exam within five years of diagnosis and annual follow-ups thereafter.
• Type 2 Diabetes: Since undiagnosed diabetes is common, patients should have a comprehensive eye exam at diagnosis, with follow-up intervals based on DR severity.
• For moderate-to-severe NPDR, consider additional OCT, OCT-A, or electroretinography (ERG) to assess progression risk. In cases of rapid disease progression, poor glycemic control, or noncompliance, earlier referral may be warranted.

Recommended resource: Diabetic Eye Disease: A Comprehensive Look at the Optometrist’s Role

The doctors also spoke to new therapeutic treatments that are enhancing DR and diabetic macular edema (DME) management:

• Anti-VEGF injections act as first-line therapy for CI-DME and proliferative diabetic retinopathy (PDR); newer agents like faricimab and high-dose aflibercept offer longer durability.
• Panretinal photocoagulation (PRP) remains the gold standard for high-risk PDR to reduce neovascularization.
• Intravitreal corticosteroid implants may benefit pseudophakic patients or those unresponsive to anti-VEGF treatment.
• Emerging therapies: Fenofibrate (lipid-lowering agent) has shown promise in slowing DR progression, while nutritional supplementation targeting oxidative stress is an evolving area of research.

Patient education points to make

Consider the following information, as outlined in the VEE presentation, when discussing things with your patients:

After 15 years of disease duration, 80% of patients with type 1 DM will have some degree of retinopathy.

Elevated blood glucose levels and HbA1c values (less than or equal to 7%), as well as less glucose time in range assessed by continuous glucose monitoring devices, are also associated with higher rates of retinopathy.

Control of blood pressure, lipids, and management of comorbidities, such as sleep apnea, all reduce risk of progression.

Pregnancy in diabetics places increase risk of progression to severe retinopathy; however this is not the case in those with gestational diabetes.

Glucagon-like peptide-1 (GLP-1) receptor analogs are a newer, highly effective category of medication for diabetes management including semaglutide (Ozempic and Wegovy, both Novo Nordisk), and tirzepatide (Mounjaro, Eli Lilly).

Although improved glycemic control is encouraged for promotion of long-term positive outcomes, a transient worsening of retinopathy may be seen initially. (Likely related to VEGF expression, reactive oxygen species production and breakdown of the blood-retinal barrier.)

Source: “Current Strategies on Managing Diabetic Eye Disease,” presented by Mary Beth Yackey, OD, Jessica Haynes, OD, at Vision Expo East; Feb 19-22, 2025; Orlando.

This content is intended for educational purposes only and does not substitute for clinical judgment. Treatment decisions should be based on individual patient needs, professional guidelines, and a comprehensive clinical evaluation.

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