Nelson’s eye news

N E L S O N ’ S E Y E
Bulletin 1. June 2003

This is a new bulletin prepared for General Practitioners, Optometrists and
Hospital Staff. We plan about 6 bulletins per year.
We aim to update you on ‘new’ developments in ophthalmology, remind you of
important ophthalmic conditions and keep you informed of ‘comings and
goings’ in the Ophthalmology Department. Please e-mail us with any
comments or requests.
All bulletins will be available at - the eye department website. This
also has other useful eye information and patient education files.
This first bulletin looks at commonly used systemic medication and their
ocular side effects.
D r u g I n d u c e d O c u l a r T o x i c i t y

Used in the treatment of certain rheumatological disorders. The two main
potential side effects are maculopathy (irreversible) and corneal deposits.
Hydroxychloroquine, however, is much safer than Chloroquine and side
effects are unlikely in first ten years of use. Recommendations: Baseline
ophthalmic assessment on commencing drug, then after five years of
treatment, a yearly eye examination.
Commonly used for relief of nocturnal muscle cramps. Acute poisoning
causes blindness but visual loss can occur on an idiosyncratic basis in
patients taking a normal dose.
Two per cent of patients can develop bilateral swollen discs with reduction in
vision. Some improve on cessation, some do not. Advise all patients on
Amiodarone about possible visual loss – there is no role for screening.
Corneal deposits are universal, asymptomatic and reversible.
Thioridazine (Melleril)
Can cause reduced vision and poor dark adaptation if used in high doses. Chlorpromazine (Largactil)
Can cause visually insignificant lens changes. Tamoxifen
Ocular complications (retinal crystals) are uncommon.
Both systemic and topical can cause cataract and glaucoma. The exact
relationship among total dose, weekly dose and duration of administration of
steroids and cataract formation is unclear. Topical or inhaled steroids can
cause glaucoma – especially in those with a family history of glaucoma or a
worsening of glaucoma in those who already have it. There are no evidence-
based recommendations, however, it may be prudent to ask patients on
steroids to have a 1-2 yearly eye check.

Vigabatrin (Sabril)
This anticonvulsant can cause asymptomatic and irreversible peripheral visual
field defects. It is not clear whether the defect may continue to worsen with
increased duration. There is a concentric constriction of the field – worse
nasally than temporally. Recommendation: visual field test at baseline and 6
monthly thereafter. The risks / benefits of using this drug need to be carefully
assessed. Children require special consideration.


We welcome Jo Kennaway, our new orthoptist, who has joined us from
Auckland. Originally from Ireland, Jo was trained in Britain, has worked at
Moorfields Eye Hospital, London then Saudi Arabia, Auckland and now
Nelson! Jo runs the Paediatric Ophthalmology Photo Screening Service,
manages children and adults with strabismus and is a great asset to us.
Finally a summary of how we’re dealing with the waiting list, as of 1 June,
The Good News:
Patients seen since July 2002: surgery 432; outpatients – 1454 FSA, 3990
FU. Outpatients remains an area of unmet need despite us seeing 40% more
patients than the contract allows.
The Bad News:
Still waiting to be seen: surgical 252; outpatients 727 (155 have appointments,
100 semi-urgents have no appointment, 424 routine have no appointment).
The waiting time for routine referrals is currently estimated to be 3 years!!


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