Abstract
Purpose :
Dry eye syndrome is often the most common ocular complication with an estimated incidence of 1-4% in patients on immune checkpoint inhibitor (ICI) therapy for cancer (Park 2021). Dry eye is found to be significantly correlated with depression and anxiety, and improvement in dry eye symptoms leads to improvement in these mood questionnaire scores. (Bitar 2019). It is crucial to us to quantify the risk and severity of dry eye in patients who use ICIs, as there are no previous prospective studies. Therefore, we are currently evaluating an exploratory, prospective case series study to adequately carry out pharmacovigilance and provide comprehensive healthcare in this patient population.
Methods :
Schirmer's test, Lissamine green staining, and OSDI scores were assessed at initial presentation and at most recent follow-up for 16 subjects (63% female, 37% male) undergoing ICI for primary malignancies who were referred to an ophthalmologist for ocular symptoms from two sites: The Pontifical Catholic University of Chile and Johns Hopkins Hospital. Wilcoxon Rank test was used to calculate significant differences between initial and final median scores for each dry eye test. The study was approved by the Johns Hopkins Medical Institution’s IRB and follows the Declarations of Helsinki.
Results :
Median age of our patients was 70 years old. Pembrolizumab was the most common ICI used (50%) followed by Nivolumab (19%). ICI treatment duration ranged from to 11 to 43 months. Lung (31%) and colon (19%) were the most common cancer types being treated. Various dry eye treatments were utilized by our patients, as 87.5% used preservative free artificial tears, 25% used cyclosporine, 19% used prednisolone acetate, 6% used fluorometholone, 6% used loteprednol, 25% used warm compresses, and 13% used punctal plugs. Initial and final median OSDI scores were 19 and 11 respectively (p=0.40). Initial and final median Schirmer 1 scores were 5.5 mm were 3.5 mm respectively (p=0.39). Initial and final median Lissamine green scores were 0.5 and 0 respectively (p=0.19).
Conclusions :
Dry eye treatment modalities including artificial tears, immunomodulatory, and non-pharmacological agents were highly utilized in patients with ICI-associated dry eye; however, there was no significant change in quantitative dry eye testing scores between initial and final follow-up in this preliminary patient series.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.