Chemotherapy and Vision

Chemotherapy is most commonly used for non ocular metastatic tumors and for various forms of eye cancer. Chemotherapeutic agents for eye cancers are typically employed for retinoblastoma and conjunctival tumors.

In the case of retinoblastoma, these drugs are typically employed either to shrink the intraocular tumor, "chemoreduction," or to treat metastatic disease. Chemoreduction of intraocular retinoblastoma is performed to save eyes and vision and therefore has a huge potential impact on vision (vision sparing). After reduction, when tumors are smaller they are more amenable to treatment with laser or cryotherapy. On the other hand, chemoreduction carries an additional risk of radiation sensitization of the normal retina. Therefore, there is a new risk of vision loss with subsequent radiation (should that be needed). In contrast, when chemotherapy is used for the treatment of metastatic retinoblastoma, ocular side-effects are less important than saving the child's life.

Topical chemotherapy (chemotherapy eye drops) have been popularized for treatment of conjunctival cancers. Squamous conjunctival neoplasia and melanoma (PAM with atypia) are the most commonly treated tumors. Advantages of topical treatment are that it is non surgical, diffuse and repeatable. Squamous tumors have been found to be exquisitely sensitive to topical therapy. To date, no vision threatening side effects of mitomycin eye drops for conjunctival cancers have been reported.

The most common use of chemotherapy is for patients with metastatic cancers (e.g. breast, lung, and prostate). In my experience, there have been rare reports of vision loss associated with the use of these drugs. What is commonly reported (by patients) are symptoms of dryness of their eyes. One quick way to know if you are suffering from dry eyes related to chemotherapy, is to ask if you also have dry mouth. If you do, you can tell that the chemotherapy is causing dysfunction of the glands which secrete tears and saliva. If you have symptoms related to chemotherapy, you may want to have an eye examination by an ophthalmic oncologist.

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