Home For Eye Doctors Patient and PCP letter templates
Patient and PCP letter templates
Editable text for baseline exams and follow-up on GLP-1 medicines
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Copy, edit, and paste these into your own letterhead or EHR. Replace bracketed text and delete lines that do not apply. Keep the medication decision with the prescriber and the patient. For a suspected or confirmed NAION letter, see Communicating with prescribers.
Template 1: Patient letter after a baseline exam (plain language)
Dear [Patient name],
Thank you for coming in on [date] for an eye exam while you are [starting / taking] [medicine name].
What we found: [Your eyes are healthy. / We found (finding) that we will keep an eye on.] We took pictures of your optic nerve and retina (OCT, OCT angiography, and retinal photos with autofluorescence). These give us a record to compare against at future visits. They do not predict or prevent sudden eye problems.
What you should know: The FDA has added a warning to GLP-1 medicines about a possible increased risk of a rare optic nerve problem called NAION. The chance is low, and for many people the benefits of the medicine outweigh this risk. Please do not stop your medicine without talking to the doctor who prescribes it.
Please get same-day care if you notice sudden vision loss, a dark shadow, or a missing part of your vision in either eye. Call us at 570-453-2020. If you are over 50 and also have a new headache, jaw pain when chewing, or scalp tenderness, go to the emergency department.
Keeping healthy: Keep up with exercise, a healthy diet, and regular visits with your usual doctors, even if they did not prescribe your GLP-1 medicine. As you lose weight, ask them to review your blood pressure and cholesterol medicines. Tell them if you feel dizzy or lightheaded, especially in the morning.
Next visit: [interval / date].
Sincerely, [Clinician name, credentials] [Practice name, phone]
Template 2: Letter to the primary care clinician or GLP-1 prescriber (baseline)
Dear Dr. [name],
I saw your patient [name, DOB] on [date] for a comprehensive dilated eye exam related to [planned / current] [agent, dose, start date].
Findings: Visual acuity [OD / OS]. Optic discs: [C/D, crowding, drusen, pallor]. Retina: [no diabetic retinopathy / (stage) / DME]. Baseline OCT RNFL/GCL, OCT angiography, and fundus photographs with autofluorescence are on file.
Considerations: As you know, the FDA (Nov 9, 2026) added a potential increased risk of NAION to GLP-1 RA labeling; the absolute risk is low. [Given (finding), I suggest (counseling on sudden vision loss / gradual A1c lowering with retinal follow-up in __ months / evaluation for sleep apnea).] I defer the medication decision to you and the patient.
Blood pressure: As weight falls, I would be grateful if antihypertensive dosing and timing could be reviewed, including bedtime dosing, to avoid hypotension, particularly at night. (This reflects my clinical opinion; it is not an established guideline.)
Follow-up here: [interval]. I have asked the patient to seek same-day care for any sudden vision loss.
For same-day questions or evaluations: [cell / direct line]. General: [phone], fax [fax].
Sincerely, [Clinician name, credentials]
Template 3: Letter to the usual PCP when someone else prescribes the GLP-1 RA
Dear Dr. [name],
Your patient [name, DOB] is taking [agent], prescribed by [prescriber / telehealth service], and has lost about [amount] since [date]. I saw them on [date] for an eye exam.
With significant weight loss, blood pressure and lipid needs can change. I would appreciate a review of their antihypertensive and lipid-lowering regimen at their next visit, with attention to orthostatic or nocturnal hypotension. (My clinical opinion, not an established guideline.) Eye findings: [summary]. Follow-up here: [interval].
Sincerely, [Clinician name, credentials]
Notes on use
- Share records only with the patient’s authorization or as permitted for treatment under HIPAA, and send through your secure channel.
- Use the absolute risk when you mention NAION; see Understanding the numbers and the study comparison.
- Label personal opinions as opinions, as these templates do.
Dr. Deom’s recommendation (clinical opinion / practice recommendation)
Dr. James Deom recommends that everyone starting or taking a GLP-1 medication have a comprehensive dilated eye exam with OCT, OCT angiography (OCTA), and retinal photography (fundus photos with autofluorescence) as a baseline and for follow-up, and seek same-day care for sudden vision loss.
This is his clinical opinion and practice recommendation, not a society mandate. AAO and NANOS do not recommend routine examination solely to predict NAION, and no exam or imaging test reliably predicts or prevents an acute event. The baseline is intended to document disc anatomy and retinal status for later comparison and to detect other eye disease. See the study comparison for where professional positions agree and differ.
Dr. James Deom’s personal clinical thought
This is his opinion, not established evidence. It is not a finding from the studies or a position of the FDA, EMA, AAO, NANOS, or AOA.
As patients lose weight and their overall health improves on GLP-1 medicines, blood pressure and cholesterol medicines are often not re-addressed. Over-treatment of blood pressure may lead to hypotension, which can worsen at night and could cause nighttime hypoperfusion of the optic nerve. That sequence would fit the typical presentation of NAION (vision loss noticed on waking).
He recommends that people on GLP-1 medicines also improve exercise and diet, and keep regular visits with their usual doctors, even if that clinician did not prescribe the GLP-1, so the rest of their care, including blood pressure, is maintained.
For prescribers: consider reviewing antihypertensive dosing and timing (including bedtime dosing) as weight drops. Coordinate changes with the patient’s usual clinician when someone else wrote the GLP-1 prescription.
How to reach us
Same-day evaluation: providers can call the office at 570-453-2020 (fax 570-453-1020), or refer a patient or ask a question by email. Patients can schedule an exam online.
For privacy, please don’t include patient names or other identifying details in email. Our team will call to schedule and gather details securely.
General contact and referrals: Hazleton Eye Specialists, phone 570-453-2020, fax 570-453-1020. See Referral information for what to send.
Medical disclaimer. These templates are educational and intended for licensed eye-care professionals. They are not a clinical practice guideline and do not replace clinical judgment, product labeling, or specialty consultation. Information is current as of the “last reviewed” date.