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Screening for ocular toxicity in asymptomatic patients treated with tamoxifen
J S Heier1, R A Dragoo, R W Enzenauer
1Ophthalmology Service, Fitzsimons Army Medical Center, Aurora, CO 80045-5001.
Abstract:
Tamoxifen is an antiestrogen drug used in the treatment of patients with breast cancer that is being studied for use in patients at high risk for developing breast cancer. Case reports have documented ocular toxicity caused by tamoxifen in patients with visual symptoms. We attempted to determine the prevalence of ocular toxicity in visually asymptomatic tamoxifen-treated patients. We performed extensive ocular examinations on 135 visually asymptomatic tamoxifen-treated patients. Two patients (1.5%) had intraretinal refractile crystals consistent with tamoxifen retinopathy. Both patients were without visual symptoms or visual loss. Corneal crystals, macular edema, and optic nerve changes were absent. The cumulative tamoxifen doses of these two patients were 10.9 and 21.9 g, respectively. For the 135 patients studied, the mean cumulative dose was 17.2 g, with a standard deviation of 13.0. We do not believe the relatively uncommon finding of tamoxifen-related ocular toxicity merits special screening for such disease.
Insights
Ocular toxicity from tamoxifen (an antiestrogen drug) is rare in patients without visual symptoms. Only 1.5% of asymptomatic patients showed signs of tamoxifen retinopathy, suggesting routine screening may not be necessary.
Area of Science:
- Ophthalmology
- Oncology
- Pharmacology
Background:
- Tamoxifen is an antiestrogen medication used for breast cancer treatment and prevention in high-risk individuals.
- Ocular toxicity has been reported in patients experiencing visual symptoms while on tamoxifen therapy.
Purpose of the Study:
- To determine the prevalence of ocular toxicity in visually asymptomatic patients undergoing tamoxifen treatment.
- To assess the incidence of tamoxifen retinopathy in a cohort of patients without reported visual disturbances.
Main Methods:
- Comprehensive ocular examinations were conducted on 135 patients treated with tamoxifen who reported no visual symptoms.
- Evaluations included assessments for intraretinal crystals, corneal crystals, macular edema, and optic nerve abnormalities.
Main Results:
- Two patients (1.5%) exhibited intraretinal refractile crystals, indicative of tamoxifen retinopathy.
- These affected patients were asymptomatic, with no reported visual symptoms or vision loss.
- No instances of corneal crystals, macular edema, or optic nerve changes were observed in the study group.
Conclusions:
- The occurrence of tamoxifen-related ocular toxicity in visually asymptomatic patients is uncommon (1.5%).
- The findings suggest that routine ocular screening for tamoxifen retinopathy may not be warranted in asymptomatic patients.
- Further research could explore the long-term implications and specific risk factors for developing ocular toxicity.