By Johnny Rigg
MD Anderson is one of a few cancer centers with a strong and growing ophthalmology section. We talked to Stella Kim, M.D., associate professor in the Department of Head and Neck Surgery, about eye problems that may occur as the result of cancer treatment.
How often do patients undergoing cancer treatment encounter problems with their vision?
Many people experience ocular symptoms during cancer treatment. Such symptoms may include ocular irritation, dryness, redness, pain, tearing, sensitivity to light and blurred vision.
Fortunately, most eye problems during cancer treatment are relatively minor and can be managed. There are, however, very serious problems that may affect vision irreversibly. These include severe infection, inflammation, bleeding, or swelling in or around the eye.
Unfortunately, symptoms alone cannot predict what types of ocular problems the patient may be experiencing, so it's good to have an evaluation by an ophthalmologist.
What are the most common vision problems for cancer patients?
Common ocular, or eye, problems in cancer patients include ocular surface diseases (such as dry eyes, eyelid disorders, excessive tearing and ocular inflammation), cataracts (due to steroid or radiation treatment), bleeding (in the front or the back of the eye, due to low blood count) and fluctuation in a patient's refractive error (prescription changes in their glasses).
Common ocular problems for patients whose cancer involves the brain include double vision, visual field loss and optic nerve swelling. Patients on newer biologic or small molecule therapies for their cancers may also develop ocular problems, though these are relatively uncommon.
Do particular types of cancer and/or treatments affect patients' vision more than others?
Any cancer that involves the brain or central nervous system could cause vision problems. All cancer treatments that decrease patients' ability to fight infection have the potential for lowering the threshold for eye infections. All chemotherapy regimens in which steroids are included may also cause vision problems, such as cataracts.
Radiation to the eye area -- to treat head and neck cancers, cancer of the eye socket or whole brain radiation for brain cancer -- may have acute and late side effects to the eye and vision. Radiation-induced ocular problems depend on the treatment dose. Head and neck cancer patients also often need eye protection with eyelid surgery, if their cancer surgery and radiation cause misalignment of the eyelids and eye socket.
Patients with lymphoma or leukemia undergoing allogeneic (from a donor) stem cell transplantation frequently develop ocular graft vs. host disease. This can lead to severe dry eye or ocular inflammation that may result in significant decreases in vision and quality of life.
Is there anything patients can do?
Absolutely. Here are some useful tips:
- Hydrate your eyes during any treatment with preservative-free artificial tears that can be purchased over the counter.
- Use baby-shampoo (pH-balanced for the eyes) to clean the eyelids and a warm compress at bedtime to decrease inflammation on the lid's surface.
- Don't wear contact lenses during treatment as they can cause serious eye infections.
- Use UVA/UVB sunglasses to delay the progression of cataracts.
Also, patients should seek an eye evaluation immediately if vision symptoms are severe. They should report symptoms to their primary team, who can help arrange an ophthalmology evaluation, especially for patients in active treatment. Patients can also contact MD Anderson's Ophthalmology Clinic
What is MD Anderson doing to help resolve these issues and to assist patients?
MD Anderson's Section of Ophthalmology includes four full-time faculty and two consultants, and it's expanding to better serve patients.
The clinic's mission is to care for patients with eye cancer and for those with eye problems due to their disease or its treatments.
The Section of Ophthalmology has studied many ocular problems in cancer patients, and is committed to improving the vision and quality of life for them. Clinic physicians and staff care for patients in clinics and in surgery five days a week and are available for emergency eye care all day, every day.Read about this topic and much more in the spring issue of Network magazine.