The Rising Tide of Biologics: Why Optometrists Are Now on the Front Line of Ocular Safety
Nearly 60% of patients on certain advanced cancer treatments are experiencing ocular side effects, a figure that’s rapidly climbing alongside the increasing use of biologic drugs. This isn’t a future concern; it’s happening now. As these powerful medications – revolutionizing treatment for everything from autoimmune diseases to oncology – become more widespread, optometrists are uniquely positioned to detect, manage, and even prevent vision-threatening complications. The need for proactive ocular assessment in patients on biologics is no longer a niche consideration, but a critical component of comprehensive eye care.
Understanding the Biologic Revolution and Its Ocular Impact
Biologic drugs, unlike traditional pharmaceuticals, are derived from living organisms. This fundamental difference allows them to target disease mechanisms with unprecedented precision. However, that precision isn’t always limited to the intended target. “It’s attacking disease states in a completely new and novel way,” explains Carl Spear, OD, MBA, FAAO, president-elect of the American Academy of Optometry. This novel approach, while offering significant therapeutic benefits, introduces a new layer of complexity for eye care professionals.
The key to recognizing potential issues lies in awareness. Many biologic drug names share common suffixes – -mab, -cept, -fusp, or -kin – or include the term “interferon.” Optometrists, often the first point of contact for patients experiencing new symptoms, must proactively inquire about medication lists. Resources like the FDA’s Adverse Event Reporting System (FAERS) and DailyMed provide comprehensive drug information, but critical thinking remains paramount. As Sarah Lopez, OD, FAAO, Dipl-AAO, emphasizes, “You’re not going to be able to memorize every sort of side effect, but it’s important to know where to look, and don’t stop at Google.”
Navigating the Spectrum of Ocular Complications by Drug Class
The ocular side effects associated with biologics vary significantly depending on the drug class. Here’s a breakdown of key areas optometrists should be prepared to address:
Antibody-Drug Conjugates (ADCs) & Ocular Toxicity
ADCs, particularly those used in oncology (like Elahere and Tivdak), carry a significant risk of ocular toxicity, affecting up to 59% of patients. Symptoms range from keratopathy and dry eye to photophobia. Discontinuation of contact lens wear is crucial for these patients, and severe cases (grade four) may necessitate pausing or reducing the drug dosage.
Interleukin Antagonists & Tear Film Instability
Drugs like Dupixent and Adbry, used for atopic dermatitis and asthma, can disrupt the ocular surface by reducing interleukin levels. This leads to decreased goblet cell function, tear film instability, and potentially conjunctivitis. While mild to moderate cases can be managed with conventional treatments, severe reactions may require switching to alternative therapies, such as Janus kinase inhibitors, which demonstrate a more favorable ocular safety profile.
Epidermal Growth Factor Receptor Inhibitors & Lash Abnormalities
These biologics, used in cancer treatment, can cause trichomegaly – excessive eyelash growth – requiring epilation or trimming. While seemingly cosmetic, this side effect highlights the widespread impact of these drugs on ocular structures.
Immune Checkpoint Inhibitors & Intraocular Inflammation
Unlike many biologics that suppress the immune system, immune checkpoint inhibitors *boost* it. This can lead to T-cell infiltration of the uveal tract, causing uveitis, scleritis, optic neuritis, and even cranial nerve palsies. A history of uveitis significantly increases the risk of recurrence in patients on these medications.
Interferons & Microvascular Injury
Interferons, used for a variety of conditions, can cause vascular permeability and endothelial dysfunction, leading to retinal hemorrhages and occlusions. Discontinuation of drugs like besremi and PEGASYS is recommended if ocular side effects are observed, emphasizing the importance of close communication between eye care providers and the patient’s medical team.
The Future of Biologic-Related Ocular Care: Proactive Monitoring and Personalized Management
The landscape of biologic therapies is constantly evolving, with new drugs and indications emerging rapidly. This necessitates a shift towards proactive ocular monitoring for all patients on these medications. Expect to see increased integration of advanced diagnostic technologies – such as corneal topography, tear film analysis, and optical coherence tomography (OCT) – to detect subtle changes before they become clinically significant. Furthermore, personalized management strategies, tailored to the specific drug and individual patient factors, will become increasingly important. The role of the optometrist isn’t just to react to problems, but to anticipate and prevent them.
What steps are *you* taking to prepare for the growing wave of patients on biologic therapies? Share your strategies and insights in the comments below!
