OPHTHALMOLOGY: Eyes vulnerable to toxicity of drug therapies

[Guest guest]

Almost all allopathic drugs have a toxicity that will affect your body

adversely. Everyone must choose for themselves what to take or not take, but I

believe it should be an informed decission.

 

If someone decides to take something, they should at least learn about what they

are considering taking in an indepth manner and in that way there should be

fewer suprises. I urge you to find out for yourselves and not by accepting what

someone else has to say.

 

Frank

 

http://www.medicalpost.com/mpcontent/article.jsp?content=20030930_094444_1188

 

September 30, 2003 Volume 39 Issue 35

 

 

OPHTHALMOLOGY: Eyes vulnerable to toxicity of drug therapies

 

By Louise Gagnon

 

OTTAWA – Ophthalmologists have to be more involved in patient treatment

decisions so serious side-effects that occur with systemic and topical drug

therapies can be reduced, says Dr. Bernard Hurley, chief resident in the

department of ophthalmology at the University of Ottawa.

 

" As ophthalmologists, we have a role to educate other physicians, in particular

primary care physicians, about the toxicity of these medications, " said Dr.

Hurley in an interview after his presentation at the Sally Letson Symposium.

 

" Our role is . . . to develop screening recommendations. Once we have these, we

can make other physicians aware of them, so appropriate referrals can be made to

us when patients are started on toxic medications. "

 

He cited as an example the loss of vision that can occur with the administration

of amiodarone to avoid cardiac arrhythmia.

 

Antimalarial drugs, inhaled steroids, hormone replacement therapy and even

nonsteroidal anti-inflammatory drugs prescribed following cataract surgery also

carry risks to the health of the eye that need to be considered, Dr. Hurley

said.

 

The clinical exam is probably not the most effective means to detect toxic

effects, he said.

 

" By the time we (ophthalmologists) see the effect, it's probably too late, " he

said. " There are probably better ways of detecting a toxic effect, such as the

multifocal ERG (electroretinogram) and the Amsler Grid, which tests the central

part of the retina. Those tests will pick up the toxicity even earlier, so a

drug therapy can be stopped even earlier. "

 

While it is generally a challenge to predict which patients are at greater risk

of loss of visual acuity linked to drug therapy, factors such as the strength of

the dosage, the time the patient has been on the medication and patient weight

can influence the risk of adverse effects.

 

" You have to consider the whole patient, " said Dr. Hurley. " The degree of lean

body mass will help determine the risk of toxicity, for instance. "

 

The danger to the eye in taking a cardiac antiarrhythmic, such as amiodarone, is

if it affects the optic nerve and retina.

 

Dr. Hurley said there is ongoing controversy about screening patients for taking

amiodarone. Corneal deposits, thought to be a tell-tale sign of an adverse

reaction to amiodarone, are not predictive of vision loss, Dr. Hurley

emphasized.

 

" The corneal deposits are not related to the very toxic effects of amiodarone, "

he told the symposium. " They are present on the surface of the eye. Typically,

we don't want to alarm the patient about this (development of deposits). "

 

Ophthalmologists need to distinguish between the types of arrhythmia the patient

is experiencing (ventricular versus atrial) before they sound the alarm on

amiodarone administration.

 

" The question is if they (patients) need their medication to prevent a fatal

arrhythmia . . . a ventricular arrhythmia potentially being more fatal . . .

whereas with atrial arrhythmia, there could be other medications apart from

amiodarone that would not carry the same risks for the eye, " he said.

 

" The ocular concerns have to be kept in context. Typically, the ocular concerns

are secondary from the point of view of the treating physician. "

 

 

 

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