Eye and Vision Concerns During Cancer Treatment

It’s important that you report any eye and vision changes you experience to your health care team so they can help you manage them. Report them right away—especially those that involve any pain or loss of vision. Doing so will improve your quality of life and allow you to stick with your treatment plan. You can use a health care journal to track the timing and severity of any eye and vision changes you experience (see “Communicating With Your Health Care Team”).

Following is guidance for the most common eye and vision side effects:

• Sensitivity to light. Avoid bright lights. If you wear glasses, use tinted lenses.

• Dry eyes. Ask your health care team if over-the-counter, preservative-free artificial tears or prescription eyedrops may be right for you. For severe cases, your doctor may recommend punctal plugs—tiny medical devices placed in the tear ducts to help prevent the draining away of tears, helping to keep eyes moist.

• Watery eyes. The blockage of passages that allow for the drainage of tears can cause watery eyes. Warm, wet compresses can help. In more extreme cases, the blockage can be removed by a minor surgical procedure, helping the eyes to drain more efficiently.

• Red, swollen eyelids. This occurs when fluid collects in the tissues around the eyes. To ease symptoms, put a clean, wet cloth on your eyes for 15 minutes twice a day. Avoid wearing contact lenses or eye makeup while symptoms last.

• Floaters and flashes of light. Although in most cases these side effects don’t require treatment, let your health care team know if you experience them, especially if you find your vision is affected (blurriness for example). Flashes of light may be a warning sign of retinal detachment.

Additionally:

• Speak to your health care team about getting support accessories for your home. These can include stabilizer bars for the bathtub or shower and devices to assist with balance. Your health care team may also be able to provide information about home-based services that help with home navigation and the completion of tasks and activities.

• Inquire about at-home eye activities. Blinking exercises and eyelid massages can help with dry eyes. Ask a member of your health care team if these may be right for you, and if they have any specific guidance.

• Ask for help. Your family members and friends will likely be a strong source of support at this time. For example, if you’re sensitive to light and are not comfortable driving, ask friends and family members to take turns driving you to appointments. You can also ask for help in preparing meals and grocery shopping.

If possible, visit an ophthalmologist prior to beginning treatment, so they can perform a detailed examination of your eyes and take baseline measurements of the function of your retina and optic nerve. Specialized tests, such as visual field and optical coherence tomography, may also be performed. If you do not routinely see an ophthalmologist, ask your health care team for a recommendation.

You should visit an ophthalmologist regularly during treatment. Ask your health care team for their recommendation on the frequency, as it will depend on the type of treatment you are receiving and if you are experiencing any eye or vision side effects. Be prepared to tell the ophthalmologist about your type and stage of cancer and the specifics of the treatment you are receiving.

A multi-disciplinary approach is essential in the management of eye and vision changes during cancer treatment. Depending on the type of treatment being given, the team can include your primary care physician, medical oncologist, radiation oncologist and ophthalmologist. Points to remember:

• Your primary care physician should be kept updated about your cancer treatment and any test results.

• Your local pharmacist is a great source of knowledge about the medications you are taking. Have all of your prescriptions filled at the same pharmacy to avoid the possibility of harmful drug interactions.

• Make sure your medical oncologist knows of any other medical conditions you have or any pain you are experiencing so they can consult with your primary care physician, radiation oncologist, ophthalmologist or other specialists as needed.

Remember, there is no such thing as over-communication.

Q: What is the difference between an optometrist and an ophthalmologist?

A: Optometrists hold a doctor of optometry (OD) degree after finishing three or more years of college and four years of optometry school. They provide primary health care for the eye, including performing eye exams and vision tests, prescribing and fitting eyeglasses and contact lenses, detecting eye abnormalities and prescribing medication that treat eye diseases.

Ophthalmologists are medical doctors who completed an internship and a residency in ophthalmology. They provide complete eye care services—all the services provided by an optometrist plus medical and surgical eye care.

It is recommended that an ophthalmologist be part of your health care team while undergoing treatment for cancer, especially if you are experiencing eye and vision issues.

Q: What is a treatment summary and why is important?

A: There are two types of treatment summaries: those you create yourself and those given to you by your surgical, medical or radiation oncologist when you complete treatment. Keeping your own records up-to-date in the form of a treatment summary can be helpful, as it allows you and your family members to have instant access to the specifics of your cancer diagnosis and treatment. A treatment summary should include:

• Your name and date of birth
• Date of diagnosis
• Prescribed therapy/therapies, including dates started and stopped and dosages when appropriate
• Dates and types of baseline and post-diagnosis testing and theresults of these tests
• Other medications and supplements you are taking
• Blood transfusion dates and results
• Names, affiliations and contact information of all members of your health care team

Ask the members of your health care team what they suggest be included. Take your personal record with you when you visit any doctor—not just your oncologist—and have it handy during telemedicine appointments.

Many cancer treatment centers provide a care plan summary (sometimes called a survivorship care plan) as a record of the care you received. This is for your records and for you to share with other members of your health care team, particularly your primary care doctor. This summary is important for your follow-up care, especially if your cancer treatment team and your primary care doctor do not use the same electronic health record system.

Q: In addition to eye and vison side effects, I am also experiencing fatigue. Do you have any guidance for me?

1. Fatigue (extreme tiredness not helped by sleep) is one of the most common side effects of many cancer treatments. If you are taking a medication, your doctor may lower the dose of the drug, as long as it does not make the treatment less effective. If you are experiencing fatigue, talk to your doctor about whether taking a smaller dose is right for you.

There are a number of other tips for reducing fatigue:

• Take several short naps or breaks during the day.
• Take short walks or do some light exercise, if possible.
• Try easier or shorter versions of the activities you enjoy.
• Ask your family or friends to help you with tasks you find difficult or tiring.
• Save your energy for things you find most important.

Fatigue can be a symptom of other illnesses, such as anemia, diabetes, thyroid problems, heart disease, rheumatoid arthritis and depression. So be sure to ask your doctor if they think any of these conditions may be contributing to your fatigue.