Breast cancer medications and vision

Effects of treatments for early-stage disease

Alvin Eisner, Shiuh-Wen Luoh

    Research output: Contribution to journalArticle

    38 Citations (Scopus)

    Abstract

    This review concerns the effects on vision and the eye of medications prescribed at three phases of treatment for women with early-stage breast cancer (BC): (1) adjuvant cytotoxic chemotherapy, (2) adjuvant endocrine therapy, and (3) symptomatic relief. The most common side effects of cytotoxic chemotherapy are epiphora and ocular surface irritation, which can be caused by any of several different regimens. Most notably, the taxane docetaxel can lead to epiphora by inducing canalicular stenosis. The selective-estrogen-receptor- modulator (SERM) tamoxifen, long the gold-standard adjuvant-endocrine-therapy for women with hormone-receptor-positive BC, increases the risk of posterior subcapsular cataract. Tamoxifen also affects the optic nerve head more often than previously thought, apparently by causing subclinical swelling within the first 2 years of use for women older than ∼50 years. Tamoxifen retinopathy is rare, but it can cause foveal cystoid spaces that are revealed with spectral-domain optical coherence tomography (OCT) and that may increase the risk for macular holes. Tamoxifen often alters the perceived color of flashed lights detected via short-wavelength-sensitive (SWS) cone response isolated psychophysically; these altered perceptions may reflect a neural-response sluggishness that becomes evident at ∼2 years of use. The aromatase inhibitor (AI) anastrozole affects perception similarly, but in an age-dependent manner suggesting that the change of estrogen activity towards lower levels is more important than the low estrogen activity itself. Based on analysis of OCT retinal thickness data, it is likely that anastrozole increases the tractional force between the vitreous and retina. Consequently, AI users, myopic AI users particularly, might be at increased risk for traction-related vision loss. Because bisphosphonates are sometimes prescribed to redress AI-induced bone loss, clinicians should be aware of their potential to cause scleritis and uveitis occasionally. We conclude by suggesting some avenues for future research into the visual and ocular effects of AIs, particularly as relates to assessment of cognitive function.

    Original languageEnglish (US)
    Pages (from-to)867-885
    Number of pages19
    JournalCurrent Eye Research
    Volume36
    Issue number10
    DOIs
    StatePublished - Oct 2011

    Fingerprint

    Aromatase Inhibitors
    Tamoxifen
    Lacrimal Apparatus Diseases
    Breast Neoplasms
    Optical Coherence Tomography
    docetaxel
    Estrogens
    Scleritis
    Selective Estrogen Receptor Modulators
    Retinal Perforations
    Optic Disk
    Uveitis
    Diphosphonates
    Traction
    Therapeutics
    Adjuvant Chemotherapy
    Gold
    Cataract
    Cognition
    Retina

    Keywords

    • Aromatase inhibitor
    • Dry eye
    • Estrogen
    • Retina
    • Short-wavelength-sensitive cones
    • Tamoxifen

    ASJC Scopus subject areas

    • Ophthalmology
    • Sensory Systems
    • Cellular and Molecular Neuroscience

    Cite this

    Breast cancer medications and vision : Effects of treatments for early-stage disease. / Eisner, Alvin; Luoh, Shiuh-Wen.

    In: Current Eye Research, Vol. 36, No. 10, 10.2011, p. 867-885.

    Research output: Contribution to journalArticle

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