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JANUARY/FEBRUARY 2020 | EYEWORLD | 63
Contact
Dugel: pdugel@gmail.com
Noecker: noeckerrj@gmail.com
Weng: Christina.Weng@bcm.edu
maculopathy are often younger (40s and 50s),
so if the patient is on pentosan, they should be
looked at.
Other drugs
Dr. Dugel mentioned the possible toxicity of
drugs used for cancer, specifically several used
to treat breast cancer.
Additionally, he mentioned MEK inhibitors
and immune checkpoint inhibitors. MEK inhib-
itors can disrupt the outer blood retinal barrier
and cause fluid to accumulate in the subretinal
space, he said. If you stop the medication, the
fluid usually resolves.
However, a lot of cancer drugs are being
used in patients with advanced disease, so it
may not be possible to stop them, he added.
Meanwhile, immune checkpoint inhibitors
target the tumor by increasing T-cell function.
The T-cells attack the tumors but can also
trigger uveitis. Additionally, Dr. Dugel said
these can cause VKH-like conditions, which can
cause multiple subretinal fluid accumulations
and RPE detachments.
Dr. Noecker mentioned drugs that alter
blood flow as potentially problematic.
For example, anti-impotence drugs can
change the circulation and may cause a drop in
circulation around the eye. In those cases, you
worry about dropping the blood supply too
much to the optic nerve or parts of the retina.
This could potentially cause vein occlusion in
the retina. There are often symptomatic chang-
es in the vision, which may be transient, Dr.
Noecker said.
Additionally, blood pressure medications
may be something to look out for, Dr. Noecker
said, as these may impact the optic nerve and
good circulation of the retina. In glaucoma,
physicians are worried about drugs that drop
diastolic pressure too low, he said.
About the doctors
Christina Weng, MD
Baylor College of Medicine
Houston, Texas
Pravin Dugel, MD
Retinal Consultants of Arizona
Phoenix, Arizona
Robert Noecker, MD
Ophthalmic Consultants
of Connecticut
Fairfield, Connecticut
Relevant disclosures
Dugel: None
Noecker: None
Weng: None
Fundus autofluorescence illustrates the "bullseye"
parafoveal ring of hyper-autofluorescence thought to
represent photoreceptor damage preceding significant
retinal pigment epithelium degeneration.
Source: Christina Weng, MD
