Importance of medication adherence in treatment needed diabetic retinopathy.

We aim to investigate the role of medication adherence history in treatment needed diabetic retinopathy (TNDR). We conducted a retrospective nested case-control study using 3 population-based databases in Taiwan. The major one was the 2-million-sample longitudinal health and welfare population-based database from 1997 to 2017, a nationally representative random sample of National Health Insurance Administration enrolled beneficiaries in 2010 (LHID2010). The national death registry and national cancer registry were also checked to verify the information. The outcome was defined as the TNDR. The Medication possession ratio (MPR) was defined as the ratio of total days of diabetes mellitus (DM) medication supply divided by total observation days. MPR ≥ 80% was proposed as good medication adherence. The association of MPR and the TNDR was analyzed. Other potential confounders and MPR ratio were also evaluated. A total of (n = 44,628) patients were enrolled. Younger aged, male sex and patients with less chronic illness complexity or less diabetes complication severity tend to have poorer medication adherence. Those with severe comorbidity or participating pay-for-performance program (P4P) revealed better adherence. No matter what the characteristics are, patients with good MPR showed a significantly lower likelihood of leading to TNDR after adjustment with other factors. The protection effect was consistent for up to 5 years. Good medication adherence significantly prevents treatment needed diabetic retinopathy. Hence, it is important to promote DM medication adherence to prevent risks of diabetic retinopathy progression, especially those who opt to have low medication adherence.

Central serous chorioretinopathy in active endogenous Cushing's syndrome.

Multiple case series have provided evidence for a relatively high incidence of central serous chorioretinopathy (CSC) in patients with active Cushing's syndrome (CS). We describe the ophthalmological status in detail of consecutive patients with active endogenous CS (either de novo or recurrent active endogenous CS) in this prospective cohort study. All patients underwent complete ophthalmological examination, including multimodal imaging, which was performed shortly after establishing the diagnosis of active CS in hypercortisolemic state. Eleven CS patients (4 men, 7 women) with active hypercortisolism were included. Abnormalities reminiscent of (subclinical) CSC were found in 3 patients. Optical coherence tomography (OCT) revealed macular subretinal fluid in 1 patient, who was diagnosed as having active CSC and was successfully treated with half-dose photodynamic therapy. Two other patients showed CSC-like abnormalities: an unilateral pseudovitelliform lesion on OCT and hyperfluorescent changes on fluorescein angiography in one patient, and unilateral leakage on fluorescein angiography in the other patient. Mean subfoveal choroidal thickness on enhanced depth imaging OCT was 270 ± 40 µm (range, 178 - 357 µm). Retinal abnormalities resembling (subclinical) CSC may be more common than previously thought in patients with active CS, and may exist even in patients without visual complaints. Clinicians should have a low threshold for ophthalmological evaluation in case of a CS patient with visual symptoms since there may be therapeutic opportunities to prevent vision loss.

Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study.

BACKGROUND: Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. METHODS: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older. FINDINGS: Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change -0·2% [95% UI -1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by -15·4% [-16·8 to -14·3], while avoidable MSVI showed no change (0·5% [-0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7-18·0]), followed by glaucoma (3·6 million cases [2·8-4·4]), undercorrected refractive error (2·3 million cases [1·8-2·8]), age-related macular degeneration (1·8 million cases [1·3-2·4]), and diabetic retinopathy (0·86 million cases [0·59-1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2-101·0]) and cataract (78·8 million cases [67·2-91·4]). INTERPRETATION: Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached. FUNDING: Brien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.

Antipsychotic pitfalls: idiopathic intracranial hypertension and antipsychotic-induced weight gain.

Idiopathic intracranial hypertension (IIH) is a condition associated with poor vision and headaches that can cause disability and reduced quality of life. The onset of IIH is typically associated with sudden weight gain and obesity, which may be due to first-generation or second-generation antipsychotics. This case involved the use of quetiapine in an obese, 28-year-old woman; she gained significant weight after starting the antipsychotic and later developed headaches and blurred vision. Reducing quetiapine and administering acetazolamide significantly improved her symptoms within 4 weeks. This case reminds physicians to consider IIH as a cause of headache and vision loss in patients who have gained weight after starting or increasing quetiapine.

Nanoscale delivery systems in treatment of posterior ocular neovascularization: strategies and potential applications.

Pathologic posterior neovascularization of eye is a major cause of irreversible vision loss and limitations of therapeutics to be successfully delivered to back of the eye has been a main obstacle for its effective treatment. Current pharmacological treatment using anti-VEGF agents being delivered intravitreally are effective but complicated due to anatomical and physiological barriers, as well as administration of high and frequent doses. With expanding horizons of nanotechnology, it can be possible to formulate promising nanoscale delivery system to improve penetration and sustained the release of therapeutic in posterior segment of the eye. Taking into consideration advances in the field of nanoscale delivery systems, this special report focuses on emerging strategies and their applications for treatment of posterior ocular neovascularization.

Rapid assessment of avoidable blindness in Papua New Guinea: a nationwide survey.

OBJECTIVE: To estimate the prevalence and main causes of blindness and vision impairment in people aged 50 years and older in Papua New Guinea (PNG). DESIGN: National cross-sectional population-based survey in National Capital District (NCD), Highlands, Coastal and Islands regions. METHODS: Adults aged 50 years and above were recruited from 100 randomly selected clusters. Each participant underwent monocular presenting and pinhole visual acuity (VA) assessment and lens examination. Those with pinhole VA<6/12 in either eye had a dilated fundus examination to determine the primary cause of reduced vision. Those with obvious lens opacity were interviewed on barriers to cataract surgery. RESULTS: A total of 4818 adults were examined. The age-adjusted and sex-adjusted prevalence of blindness (VA <3/60), severe vision impairment (SVI, VA <6/60 but ≥3/60), moderate vision impairment (MVI, VA <6/18 but ≥6/60) and early vision impairment (EVI, VA <6/12 but ≥6/18) was 5.6% (95% CI 4.9% to 6.3%), 2.9% (95% CI 2.5% to 3.4%), 10.9% (95% CI 9.9% to 11.9%) and 7.3% (95% CI 6.6% to 8.0%), respectively. The main cause of blindness, SVI and MVI was cataract, while uncorrected refractive error was the main cause of EVI. A significantly higher prevalence of blindness, SVI and MVI occurred in the Highlands compared with NCD. Across all regions, women had lower cataract surgical coverage and spectacle coverage than men. CONCLUSIONS: PNG has one of the highest reported prevalence of blindness globally. Cataract and uncorrected refractive error are the main causes, suggesting a need for increased accessible services with improved resources and advocacy for enhancing eye health literacy.

Reducing avoidable visual impairment in elderly home healthcare patients by basic ophthalmologic screening.

PURPOSE: To investigate the prevalence of potential age-related eye conditions in elderly who are assisted by home healthcare nurses. The number of referrals to the general practitioner (GP), feasibility of screening and associations between vision loss and health outcomes were also studied. METHODS: Cross-sectional study in which trained home healthcare nurses screened the eyes of 151 patients [mean age 80 (50-96 years)] using their available correction, with VISION 2020 Netherlands screeners (e.g. acuity/field loss). Health outcomes were assessed with questionnaires. RESULTS: Distance decimal visual acuity was ≤0.3 in 20.5% (unilateral) and 19.9% (bilateral) of patients, and near visual acuity was ≤0.4 in 17.7% (unilateral) and 33.3% (bilateral). Macular dysfunction was present in 21.5% (unilateral) and 8.3% (bilateral) and peripheral field problems in 11.4% (unilateral) and 7.9% (bilateral). GP referrals were proposed in 21.5%; in 40%, the GP or ophthalmologist was already aware of eye problems. Although health problems were prominent in participants (8.6% fractures, 22% depression and 18% anxiety), no significant associations were found between vision loss and self-reported outcomes. CONCLUSION: Sixty per cent of frail elderly home healthcare patients had an ophthalmologic condition. Although a large number was already known in eye health care, >20% was referred with an unrecognized ophthalmologic problem. Basic ophthalmologic screening by home healthcare nurses might be a potentially relevant tool to reduce the burden of age-related vision loss, contributing to the joint World Health Organization - VISION 2020 initiative to eliminate avoidable blindness. Relevant health outcomes do not seem to be clearly related to having visual impairment, but rather to having general health problems.

Preventing blindness and visual impairment in Europe: What do we have to do?

Severe visual impairment and blindness are significant public health problems worldwide. Four-fifths of cases of blindness can be prevented or cured. The World Health organisation's 'Universal Eye Health: A Global Action Plan 2014-2019' and the European Society of Ophthalmology's Pilot Committee on Public Eye Health are aiming to decrease the prevalence of blindness in Europe and around the world. Starting discussions addressing possible actions and advocacies to improve current circumstances in public eye health is a common task of ophthalmologists and public health specialists in Europe.

Blindness and Visual Impairment Profile and Rapid Assessment of Avoidable Blindness in South East Asia: Analysis of New Data. 2017 APAO Holmes Lecture.

PURPOSE: The International Agency for Prevention of Blindness (IAPB) South East Asia region (SEAR) that consists of 11 countries contains 26% of the world's population (1,761,000,000). In this region 12 million are blind and 78.5 million are visually impaired. This amounts to 30% of global blindness and 32% of global visual impairment. DESIGN: Rapid assessment of avoidable blindness (RAAB) survey analysis. METHODS: RAAB, either a repeat or a first time survey, was completed in 8 countries in this decade (2010 onwards). These include Bangladesh, Bhutan, India, Indonesia, Maldives, Sri Lanka, Thailand, and Timor Leste. RESULTS: Cataract is the principal cause of blindness and severe visual impairment in all countries. Refractive error is the principal cause of moderate visual impairment in 4 countries: Bangladesh, India, Maldives, and Sri Lanka; cataract continues to be the principal cause of moderate visual impairment in 4 other countries: Bhutan, Indonesia, Thailand, and Timor Leste. Outcome of cataract surgery is suboptimal in the Maldives and Timor Leste. CONCLUSIONS: Rigorous focus is necessary to improve cataract surgery outcomes and correction of refractive error without neglecting the quality of care. At the same time allowances must be made for care of the emerging causes of visual impairment and blindness such as glaucoma and posterior segment disorders, particularly diabetic retinopathy.

Tolerable rates of visual field progression in a population-based sample of patients with glaucoma.

AIMS: To provide population-based data on the maximum tolerable rate of progression to avoid visual impairment (maxTRoP_VI) and blindness (maxTRoP_BL) from open-angle glaucoma (OAG). METHODS: Participants with OAG in the Thessaloniki Eye Study (cross-sectional, population-based study in a European population) were included in the analysis. Visual impairment was defined as mean deviation (MD) equal to or worse than -12dB and blindness as MD equal to or worse than -24dB. Additional thresholds for visual impairment were tested. For each participant maxTRoP_VI was defined as the rate of progression which would not lead to visual impairment during expected lifetime. MaxTRoP_BL was defined accordingly. Both parameters were calculated for each OAG subject using age, sex, MD and life expectancy data. The eye with the better MD per subject was included in the analysis. RESULTS: Among 135 subjects with OAG, 123 had reliable visual fields and were included in the analysis. The mean age was 73±6 years and the median MD was -3.65±5.28dB. Among those, 69.1% would have a maxTRoP_VI slower than -1dB/year and 18.7% would have a maxTRoP_VI between -1 and -2dB/year. Also, 72.4% would have a maxTRoP_BL slower than -2dB/year. For all tested thresholds for visual impairment, approximately 86% of the OAG study participants would not be able to tolerate a rate of progression equal to or faster than -2dB/year. CONCLUSIONS: The majority of patients with glaucoma in our study would have a maximum tolerable rate of progression slower than -1dB/year in their better eye. Patient-tailored strategies to monitor the visual field are important, but raise the issue of feasibility with regard to the number of visual field tests needed.

Time to development of ocular syphilis after syphilis infection.

To provide an estimate of the incubation period of ocular syphilis based on serology using both clinical data and stored serum samples, we retrospectively reviewed patients with HIV-1 infection who presented with ocular syphilis between August 1997 and July 2015 in a tertiary hospital in Japan. The incubation period of ocular syphilis was defined as the time from syphilis infection to the development of ocular symptoms due to ocular syphilis. During the study period, 20 patients were diagnosed with ocular syphilis and 8 patients were enrolled in the present study. All patients were Japanese men who have sex with men with a median age of 46 years (IQR 41.5-53.5). The median CD4 count was 668.5/µL (IQR 567.8-734.3) and 5 of the 8 patients had HIV-1 viral load of less than 50 copies/mL. All study patients presented to our clinic because of the development of ocular symptoms, and they did not have any other symptoms compatible with primary, secondary, or tertiary syphilis. The median time between syphilis infection and development of ocular symptoms was 11 months (IQR 4-19, range 2.5-45). Seven out of eight (87.5%) cases developed ocular syphilis within 2 years of syphilis infection. Ocular syphilis should be suspected even in patients with early syphilis who present with ocular symptoms. Moreover, routine serologic screening for syphilis among patients with HIV-1 infection is critical for prevention of irreversible visual loss in ocular syphilis cases.

Integrating primary eye care into global child health policies.

Globally, approximately 75% of blind children live in low-income countries (LICs). Almost half of blindness and low vision in LICs is due to avoidable causes such as corneal scarring from measles infection, vitamin A deficiency disorders, use of harmful traditional eye remedies, ophthalmia neonatorum and cataract.

Cataract Surgery in Patients with Diabetes: Management Strategies.

Diabetes is a chronic systemic disease that affects nearly one in eight adults worldwide. Ocular complications, such as cataract, can lead to significant visual impairment. Among the worldwide population, cataract is the leading cause of blindness, and patients with diabetes have an increased incidence of cataracts which mature earlier compared to the rest of the population. Cataract surgery is a common and safe procedure, but can be associated with vision-threatening complications in the diabetic population, such as diabetic macular edema, postoperative macular edema, diabetic retinopathy progression, and posterior capsular opacification. This article is a brief review of diabetic cataract and complications associated with cataract extraction in this population of patients.

Retinal Prosthesis System for Advanced Retinitis Pigmentosa: A Health Technology Assessment Update.

BACKGROUND: Retinitis pigmentosa is a group of inherited disorders characterized by the degeneration of the photoreceptors in the retina, resulting in progressive vision loss. The Argus II system is designed to restore partial functional vision in patients with profound vision loss from advanced retinitis pigmentosa. At present, it is the only treatment option approved by Health Canada for this patient population. In June 2016, Health Quality Ontario published a health technology assessment of the Argus II retinal prosthesis system for patients with advanced retinitis pigmentosa. Based on that assessment, the Ontario Health Technology Advisory Committee recommended against publicly funding the Argus II system for this population. It also recommended that Health Quality Ontario re-evaluate the evidence in 1 year. The objective of this report was to examine new evidence published since the 2016 health technology assessment. METHODS: We completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, and patient preferences related to the Argus II system. We performed a systematic literature search for studies published since the 2016 Argus II health technology assessment. We developed a Markov decision-analytic model to assess the cost-effectiveness of the Argus II system compared with standard care, and we calculated incremental cost-effectiveness ratios over a 20-year time horizon. We also conducted a five-year budget impact analysis. Finally, we interviewed people with retinitis pigmentosa about their lived experience with vision loss, and with the Argus II system. RESULTS: Four publications from one multicentre international study were included in the clinical review. Patients showed significant improvements in visual function and functional outcomes with the Argus II system, and these outcomes were sustained up to a 5-year follow-up (moderate quality of evidence). The safety profile was generally acceptable.In the base case economic analysis, the Argus II system was cost-effective compared with standard care if the willingness to pay was more than $97,429 per quality-adjusted life-year. We estimated that funding the Argus II system would cost the province $0.71 to $0.78 million per year over 5 years, assuming 4 implants per year.People with lived experience spoke about the challenges of retinitis pigmentosa, including the gradual but persistent progression of the disease; its impact on their quality of life and their families; and the accessibility challenges they faced. Those who used the Argus II system spoke about its positive impact on their quality of life. CONCLUSIONS: Based on evidence of moderate quality, the Argus II retinal prosthesis system improved visual function, real-life functional outcomes, and quality of life in patients with advanced retinitis pigmentosa. The Argus II system is expensive, but the cost to publicly fund it would be low, because of the small number of eligible patients. The Argus II system can only enable perception of light/dark and shapes/objects, but these advancements represent important gains for people with retinitis pigmentosa in terms of mobility and quality of life.

Estudio sobre la prevención de la discapacidad visual en pacientes diabéticos del municipio Playa / Study on the prevention of visual disability in diabetic patients from Playa municipality

Objetivo: determinar el comportamiento de la discapacidad visual por retinopatía diabética en dos áreas de salud del municipio Playa. Métodos: se realizó una investigación exploratoria, observacional y descriptiva, en la que se practicó un examen oftalmológico a los diabéticos, donde se evaluó por especialistas de retina la presencia de lesiones en el fondo de ojo y su asociación con otras afecciones oftalmológicas. Resultados: las dos áreas de salud presentaron características demográficas y de la enfermedad diabética similares. Las formas no proliferativas de los dos grupos se presentaron en el 8,5 y 4,8 por ciento, no así la forma proliferativa, que fue de 2 y 2,7 por ciento. La maculopatía leve fue más frecuente que la severa en los dos grupos. La prevalencia de algún grado de retinopatía y de maculopatía fue de 13,1 y 10,6 por ciento, respectivamente. El mayor porcentaje de pacientes en los dos grupos de estudio no había sido examinado o había transcurrido más de un año de haberse realizado un fondo de ojo. Se encontró un número elevado de ojos de pacientes con catarata evidente (31,2 y 26,5 por ciento. La prevalencia de baja visión (10,9 y 11 por ciento) y de ceguera (2,9 y 2,7 por ciento) fue similar en los dos grupos, pero sus causas pueden ser reversibles, prevenibles y tratables. Conclusiones: a pesar de que la muestra fue pequeña y la prevalencia de retinopatía y/o maculopatía fue baja, se presentaron pacientes con discapacidad visual prevenible y tratable(AU)

Objective: to determine the situation of visual disability caused by diabetic retinopathy in two health areas of Playa municipality. Methods: a descriptive, observational and exploratory research study was conducted where eye exam was performed in diabetic patients to evaluate the presence of fundus oculi lesions and their association with other ophthalmological diseases. Results: it was found that the two health areas showed similar demographic characteristics and diabetic disease features. Non-proliferative forms of the two groups occurred in 8.5 and 4.8 percent whereas the proliferative form was seen in 2 percent and 2.7 percent. Mild maculopathy was more common than the severe one in the two groups of patients. The prevalence of retinopathy and maculopathy was 13.1 and 10.6 percent, respectively. The highest percentage of patients in the two study groups had not been examined or their fundus oculi test had been performed over a year ago. There was a high number of patients with evident cataract (31.2 and 26.5 percent). The prevalence rates of low vision (10.9 and 11 percent) and of blindness (2.9 and 2.7 percent) were almost the same in the two groups; however it should be borne in mind that their causes can be reversible, preventable and treatable. Conclusions: despite the small sample size and the low prevalence of retinopathy and/or maculopathy, there were patients with preventable and treatable vision(AU)

Estudio sobre la prevención de la discapacidad visual en pacientes diabéticos del municipio Playa / Study on the prevention of visual disability in diabetic patients from Playa municipality

Objetivo: determinar el comportamiento de la discapacidad visual por retinopatía diabética en dos áreas de salud del municipio Playa. Métodos: se realizó una investigación exploratoria, observacional y descriptiva, en la que se practicó un examen oftalmológico a los diabéticos, donde se evaluó por especialistas de retina la presencia de lesiones en el fondo de ojo y su asociación con otras afecciones oftalmológicas. Resultados: las dos áreas de salud presentaron características demográficas y de la enfermedad diabética similares. Las formas no proliferativas de los dos grupos se presentaron en el 8,5 y 4,8 por ciento, no así la forma proliferativa, que fue de 2 y 2,7 por ciento. La maculopatía leve fue más frecuente que la severa en los dos grupos. La prevalencia de algún grado de retinopatía y de maculopatía fue de 13,1 y 10,6 por ciento, respectivamente. El mayor porcentaje de pacientes en los dos grupos de estudio no había sido examinado o había transcurrido más de un año de haberse realizado un fondo de ojo. Se encontró un número elevado de ojos de pacientes con catarata evidente (31,2 y 26,5 por ciento. La prevalencia de baja visión (10,9 y 11 por ciento) y de ceguera (2,9 y 2,7 por ciento) fue similar en los dos grupos, pero sus causas pueden ser reversibles, prevenibles y tratables. Conclusiones: a pesar de que la muestra fue pequeña y la prevalencia de retinopatía y/o maculopatía fue baja, se presentaron pacientes con discapacidad visual prevenible y tratable(AU)

Objective: to determine the situation of visual disability caused by diabetic retinopathy in two health areas of Playa municipality. Methods: a descriptive, observational and exploratory research study was conducted where eye exam was performed in diabetic patients to evaluate the presence of fundus oculi lesions and their association with other ophthalmological diseases. Results: it was found that the two health areas showed similar demographic characteristics and diabetic disease features. Non-proliferative forms of the two groups occurred in 8.5 and 4.8 percent whereas the proliferative form was seen in 2 percent and 2.7 percent. Mild maculopathy was more common than the severe one in the two groups of patients. The prevalence of retinopathy and maculopathy was 13.1 and 10.6 percent, respectively. The highest percentage of patients in the two study groups had not been examined or their fundus oculi test had been performed over a year ago. There was a high number of patients with evident cataract (31.2 and 26.5 percent). The prevalence rates of low vision (10.9 and 11 percent) and of blindness (2.9 and 2.7 percent) were almost the same in the two groups; however it should be borne in mind that their causes can be reversible, preventable and treatable. Conclusions: despite the small sample size and the low prevalence of retinopathy and/or maculopathy, there were patients with preventable and treatable vision(AU)

[Focus on popular science education of glaucoma and reduce glaucomatous low vision and blindness].

The prevention of blindness caused by glaucoma is a difficult task. In order to accomplish the task better, we need the participation of whole society and popularize relevant medical knowledge. Popular science and related knowledge of glaucoma are needed to the people especially for high risk population. If people know glaucoma better and actively join the screening of glaucoma, we can find and diagnose glaucoma earlier, avoid late treatment and reduce the glaucomatous visual function impairment. For patients who had been diagnosed with glaucoma, they should aware and accept new medical concept and technique through systemic popular science education. They should actively participate the whole procedure of the disease management and improve their compliance and confidence. Academic organization of ophthalmology should participate and guide the patient education, improve the individualized comprehensive health care for the diagnosis and treatment and third-order health care system that is suitable for the condition of our country, help improving the prognosis of glaucoma and life quality related to vision for advanced and late glaucoma. (Chin J Ophthalmol, 2017, 53: 81-84).

Bilateral Retrobulbar Optic Neuropathy Associated With Golimumab.

We report the first documented case of retrobulbar optic neuropathy associated with golimumab. A 48-year-old man was admitted with a 3-week history of progressive visual loss of his left eye. He had received a second infusion of golimumab for ankylosing spondylitis 10 days before admission. A magnetic resonance imaging scan showed enhancement of both optic nerves and visual evoked potentials were consistent with demyelinating bilateral optic neuropathy, although visual acuity drop in the right eye could not be determined because of deep amblyopia. No improvement was observed after golimumab dechallenge or corticosteroid treatment. Demyelinating complications related to treatment with tumor necrosis factor alpha inhibitors (TNFAI) have been previously described. Golimumab, a fully human monoclonal antibody, is the most recently developed TNFAI and thus, fewer adverse effects have been reported. Further studies should be developed to elucidate if variability in golimumab's pharmacokinetics or TNF receptor binding affinity could explain different safety profiles compared with other TNFAI.