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Immune checkpoint inhibitor optic nerve disorders (ICI-OND) often cause painless vision loss. Treatment with steroids and ICI cessation improves vision, and rechallenging ICI is often safe.

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Area of Science:

  • Ophthalmology
  • Neuro-oncology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are crucial cancer therapies.
  • Optic nerve disorders (OND) are potential side effects of ICIs.
  • Understanding ICI-OND clinical features and outcomes is vital.

Purpose of the Study:

  • To characterize clinical features of ICI-OND, including optic neuritis, disc edema, perineuritis, and panuveitis.
  • To evaluate management strategies and long-term outcomes for ICI-OND.
  • To assess the safety and efficacy of ICI rechallenge after ICI-OND.

Main Methods:

  • Retrospective analysis of 20 consecutive patients with ICI-OND.
  • Inclusion of 37 eyes treated at a single tertiary cancer center.
  • Data collection on clinical presentation, diagnostic tests, treatment, and outcomes.

Main Results:

  • Most ICI-OND cases presented with painless vision loss (85%), bilateral involvement (70%), and dyschromatopsia (59%).
  • Abnormal visual fields (79%), OCT (80%), and MRI (56%) were common.
  • Vision improved in 84% of eyes after steroid treatment and ICI cessation; 4 of 5 rechallenged patients tolerated ICI without recurrence.

Conclusions:

  • ICI-OND typically manifests as bilateral, painless vision decline with color vision deficits.
  • Systemic steroids and ICI cessation can restore vision to 20/40 or better.
  • ICI rechallenge appears safe in most patients after completing steroid treatment, with no recurrence of ICI-OND.