NANOSNET

I am seeing an older woman recently put on GLP-1's who has mild field loss from her ODD.

In this case, with her age, with her mild field changes, and her medical need for the drug, I am not going to mention this to her  other doctors, as I think it is just a theoretical issue now, and risk-benefits are in favor of its use..

But what if I find out that one of my teenagers with severe field loss from ODD (I have a handful) are put on these meds- has anyone faced this?  I have not found literature- thought I would see what others thing.  I think it would take years of following patijents to properly study this.

Larry, We know that ODD are a major risk factor for NAION in the young. As always, it's a question of risk vs benefit. If a young person's health is at stake, and the patient and family understand the possible added risk of a GLP-1R agonist, then, just as in adults with diabetes, obesity, etc., the benefits would seem to outweigh the risks. If the indications for the drug are "iffy" or if there are alternatives, then it's a different story.

N

The likelihood of developing an AION in the setting of ODD which are so common, is remote, albeit an increased risk vs the general population. I think to withhold any of these agents because of the theoretical risk of developing an A. IO. N. that might be increased because of GLP1 use when it is not even proven to be causal yet makes no sense to me.

Matt

I certainly agree Larry. Are these disks at "mega risk" as Jacquie Winterkorn used to say.

Scott Forman

Larry: I absolutely agree with Neil. The equation seems to be more in favor of benefit for young people.  Until we have more definitive data, I think you are doing the right thing

Peter.

thank you all

It should be a risk/benefit analysis, of course, but the error is in attempting to compare relative risk to benefit.  It should be absolute risk.  Doubling the chances of a very rare disease is far less risky, absolutely, than a 10% increase in a very common disease (think obesity, diabetes, etc.).