Tamoxifen Maculopathy

Tamoxifen Maculopathy
SYMPTOMS Typically asymptomatic in the early stages of the disease but eventually may experience central vision loss and central scotomas
SIGNS Typically bilateral
Yellow crystalline deposits in the inner retina especially near the ILM, Yellow foveal lesion, Cystoid macular edema, Lamellar macular hole, Full thickness macular hole
WORK-UP Full eye exam with dilated retinal exam, Visual field threshold 10-2, OCT analysis of the macula (cavitations that typically start in the inner nuclear layer and ellipsoid zone that eventually involve other areas of the inner and outer retina with ILM drape and disruption/thinning of the ellipsoid zone), Fluorescein Angiography, Fundus Autofluorescence, Fundus photos, Infrared retinal imaging, Watzke-Allen test, Macular photostress test, Color vision, Electrodiagnostic testing (multifocal ERG), Amsler grid
TREATMENT Give take home Amsler grid in order to monitor for change
If there is no evidence of tamoxifen maculopathy, patient needs to be monitored
If there is evidence of tamoxifen maculopathy, the dosage of Tamoxifen needs to be lowered or the Tamoxifen needs to be completely discontinued (discussion with patient's primary care provider is imperative before lowering dosage of Tamoxifen or completely discontinuing Tamoxifen)
FOLLOW-UP Baseline testing should be done on all patients taking Tamoxifen within the first year
If testing shows no evidence of tamoxifen maculopathy, the patient should next be seen back in 6-12 months (closer to 6 months if patient is concurrently getting chemotherapy)
If testing shows possible evidence of tamoxifen maculopathy, the patient should be seen back in 2-4 months (closer to 2 months if patient is concurrently getting chemotherapy)
If testing shows definitive evidence of tamoxifen maculopathy, the patient should be seen back in 2-4 months once the dosage of Tamoxifen is lowered or the Tamoxifen is completely discontinued (closer to 2 months if the patient is concurrently getting chemotherapy and/or the dosage of Tamoxifen is lowered)
ADDITIONAL LAB | TESTS None
ETIOLOGY Tamoxifen causes damage to Muller cells, photoreceptors, and the RPE because it increases accumulation of drug-lipid complexes in lysosomes and causes oxidative stress
DIFFERENTIAL DX Mac Tel, Cone dystrophy, Solar maculopathy
NOTES Typical dosing of Tamoxifen is 20-40mg a day over a 5 year period
If the patient is taking Tamoxifen at the typical dosage, the chances of getting maculopathy is less than 1%
Taking the typical dosage of Tamoxifen along with concurrently getting chemotherapy, increases the risk of maculopathy up to 10.9%
Tamoxifen Maculopathy: OCT of the macula demonstrating a large cavitation along with draping of the ILM https://imagebank.asrs.org/file/2168/tamoxifen-maculopathy
Posted in Macula, Ocular Conditions