Breast cancer treatments may spur visual, ocular side effects

Curr Eye Res. 2011;doi:10.3109/02713683.2011.594202

Various medications prescribed in the treatment of early-stage breast cancer may affect vision and ocular health, a study found.

The authors studied the visual and ocular effects of medications prescribed for three phases of treatment: adjuvant cytotoxic chemotherapy, adjuvant endocrine therapy and symptomatic relief.

"For the present, we recommend that studies of [breast cancer] survivors' cognitive function begin to record or screen for eye health and also add tests of spatial vision so that sensory deficits are not misconstrued as cognitive deficits," the study authors said.

The most common side effects of cytotoxic chemotherapy are epiphora and ocular surface irritation, which may be caused by many regimens, according to the study. Most notably, taxane docetaxel may lead to epiphora by inducing canalicular stenosis.

The selective estrogen receptor modulator tamoxifen, a longtime standard adjuvant endocrine therapy for hormone receptor-positive breast cancer, increases the risk of posterior subcapsular cataract. Tamoxifen also affects the optic nerve head by causing

subclinical swelling within 2 years in women older than 50 years, the authors said.

Tamoxifen may cause foveal cystoid spaces that increase the risk of macular hole. Tamoxifen often alters the perceived color of flashed lights detected via short-wavelength-sensitive cone response, heralding a neural-response sluggishness that can be observed clinically after about 2 years of use, according to the study.

The aromatase inhibitor anastrozole affects perception in an age-dependent manner based on change in estrogen level. Optical coherence tomography images of retinal thickness have shown it likely that anastrozole increases tractional force between the vitreous and retina, potentially raising the risk of traction-related vision loss, the authors said.