What to know about ocular management of patients undergoing cancer treatment

Jessica Steen, OD, of Nova Southeastern University College of Optometry, recapped a talk she gave at the 2024 American Academy of Optometry Annual Meeting, which covered the topic of monitoring patients receiving cancer treatment as well as effective communication strategies for optimal patient care.

Jessica Steen, OD:

We have just wrapped up the American Academy of Optometry Meeting in Indianapolis, Indiana. I had the pleasure to present with my colleague, Dr. Chris Putnam, and what we talked about were really interesting cases and interesting concepts within the management of ocular disease and the management of systemic disease with ocular complications, both from a purely optometric standpoint and then also working with our colleagues in subspecialty areas, even areas outside of the eye. Now, I think my biggest takeaway from the meeting as a whole, which really hit home with our discussion, was how we can improve clinical care.

This is the challenge that we ask ourselves as clinicians truly every day. Our management options continue to advance, our diagnostic technologies continue to develop, and it’s about how we’re able to incorporate these new technologies and management options for ultimately the improved ophthalmic care of our patients. I think taking that step back to say what’s new, what’s available, what practice patterns may be changing, and how do we apply those changes into clinical practice is really the most important takeaway from the meeting itself and also our discussion.

One of the specific topics that Dr. Putnam and I spoke about, which is something that I think is unique and something that more and more optometrists and general ophthalmologists are being exposed to, are the ocular complications related to systemic antibody-drug conjugate therapy. Specifically thinking about the management of women who have gynecologic cancer, which are often recurrent cancers or difficult-to-treat cancers. There are 2 antibody-drug conjugates that are available that have specific ocular management and monitoring and treatment requirements, one for the treatment of cervical cancer and the other for the treatment of ovarian cancer. Again, this is not a first-line treatment option for these women. These are 2 treatments that are reserved for recurrent, difficult-to-treat or metastatic disease.

Now, it’s important for optometrists and all eye care providers to understand, number 1, what the requirement, the ophthalmic monitoring requirements are, which do differ between the treatment options. For Tivdak, this is an every-3-week monitoring cycle. Truly, what to watch for in these patients is significant corneal staining, superficial punctate keratitis and conjunctival irritation, and inflammatory change. Now, for individuals who are taking Elahere, the management or monitoring requirements are a little bit different, less frequently at the recommendation of every 6 weeks, and really watching for very subtle corneal epithelial microcystic changes, changes in vision that can be accompanied by changes in corneal topography.

As we’re monitoring and as we’re treating individuals who are undergoing treatment for their gynecologic cancer, the key is to communicate with the managing oncologist and oncology team. Now, for each of these 2 therapies, because there is a true requirement, this means that the importance of completing the form letter or the form note related to the ocular findings is truly required for that patient to get their next infusion. It’s not just communicating directly, it’s not just sending an update on that patient, but it’s true formal communication that’s required.

I think that’s the other big takeaway from the meeting and the discussion itself is from a communication standpoint in working with outside specialists, subspecialists in an eye care space and in a greater medical space, how can we improve the way that we communicate with one another. We think about our current methods by fax, by phone, and then we think about technology and how technology can play a role to facilitate easier, smoother, more direct communication. I think as we move ahead, this is one more thing to be on the lookout for, is we are sharing more patients with multiple subspecialists in the tools and technologies that will become available to aid in our communication and really how that truly does make a difference to every patient that we see.

Bottom line, Academy this year truly was that experience where we get to connect with colleagues, with previous students, with residents, with friends in industry, and really talk about best practices and really bring that into our practice to now make our plans to say, “How can we do things better looking ahead?”