< Optometric Clinical Practice Recommendations
Monitoring Ocular Toxicity of Selected Medications
|Drug Classification & Generic (Brand Name)||Normal Therapeutic Dosage||Potential Visual or Sight Threatening Complications||Clinical Management Recommendations|
|600 - 800 mg QD for 1 month then 400 mg QD thereafter||Corneal degeneration, corneal depositions, photophobia, cataract, optic neuropathy, optic neuritis, papilledema||Initial Baseline Evaluation:|
Comprehensive eye examination,* detailed biomicroscopy, screening visual field, Amsler grid, color vision (blue-yellow, red-green)
Weekly home Amsler grid to detect optic nerve involvement from amiodarone
Recommended Follow-up Intervals/Testing:
Every 6 months in first year of therapy, then annually thereafter or on an as-needed basis depending on clinical findings. Repeat visual acuity, screening visual field, Amsler grid, color vision, detailed biomicroscopy, funduscopy. Central threshold visual field, fundus photography for suspected optic neuropathy.
Report these reversible adverse ocular side effects to cardiologist and/or primary care provider. Amiodarone most likely to result in corneal depositions with mild visual acuity reduction and photophobia. Protective sunwear may be indicated for photophobia. Digitalis toxicity may result in reduced visual acuity/amblyopia and color vision disturbance.
|digoxin (Lanoxin)||Depends upon blood concentration. Normal starting range 0.125 mg to 0.25 mg QD||Xanthopsia (Yellow vision), amblyopia|
Anti-Malarial 4-10, 18-26 chloroquine (Aralen) hydroxychloroquine (Plaquenil) 500 mg QD 200 - 400 mg QD Blurred vision, headache, accommodative dysfunction, nyctalopia, scotomata, phototoxicity, vortex keratopathy, irreversible retinal damage in patients on long-term high dose therapy (e.g., Bull’s eye maculopathy) Initial Baseline Evaluation: Comprehensive eye examination,* central threshold visual field, Amsler grid, color vision testing (blue-yellow), fundus photography Patient Instructions: Weekly home Amsler grid to detect maculopathy Recommended Follow-up Intervals/Testing: Every 6 months repeat visual acuity, central threshold visual field, Amsler grid, color vision testing, funduscopy. Repeat fundus photography periodically, as indicated. Therapeutic Intervention/Management: Report adverse ocular side effects to rheumatologist and/or primary care provider. Protective sunwear to reduce risk of ocular phototoxicity. Eyeglasses as needed for blurred vision and accommodative dysfunction. Electroretinogram (ERG) testing is optional; may consider if clinical findings are progressive, equivocal or unreliable.