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Biomedical subjects

Frederick W Fraunfelder

Publications and source records attributed to Frederick W Fraunfelder.

At least 19 recordsLinked to original sources
PubMed2007

Ocular adverse effects associated with systemic medications : recognition and management.

This article reviews several retrospective case series and reported adverse events regarding common ocular adverse effects related to systemic therapy. It is not intended as a comprehensive summary of these well described adverse drug reactions, nor is it intended to cover the complete spectrum of all ocular adverse effects of systemic therapy. Many systemic drugs may produce ocular toxicity, including bisphosphonates, topiramate, vigabatrin, isotretinoin and other retinoids, amiodarone, ethambutol, chloroquine and hydroxychloroquine, tamoxifen, quetiapine, cyclo-oxygenase (COX)-2 inhibitors, erectile dysfunction agents and some herbal medications. For this review, the certainty of the adverse effect profile of each medication was evaluated according to the WHO Causality Assessment Guide.A certain relationship has been established for pamidronate and alendronate as causes of scleritis, uveitis, conjunctivitis and blurred vision. Topiramate has been established as adversely causing symptoms consistent with acute angle-closure glaucoma, typically bilateral. Vigabatrin has been shown to cause bilateral irreversible visual field defects attributed to underlying medication-induced retinal pathology. Isotretinoin should be considered in the differential diagnosis of any patient with pseudotumour cerebri. Patients taking amiodarone and hydroxychloroquine should be monitored and screened regularly for development of optic neuropathy and maculopathy, respectively. Sildenafil has been reported to cause several changes in visual perception and is a possible, not yet certain, cause of anterior ischaemic optic neuropathy. Patients taking tamoxifen should also be monitored for development of dose-dependent maculopathy and decreased colour vision. COX-2 inhibitors should be included in the differential diagnosis of reversible conjunctivitis. Several herbal medications including canthaxanthine, chamomile, datura, Echinacea purpurea, Ginkgo biloba and liquorice have also been associated with several ocular adverse effects. It is the role of all healthcare professionals to detect, treat and educate the public about adverse reactions to medications as they are an important health problem.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2006

Scientific challenges in postmarketing surveillance of ocular adverse drug reactions.

PURPOSE: To highlight the challenges of postmarketing surveillance for drug-related adverse events in the practice of ophthalmology. DESIGN: A retrospective review of the medical literature and postmarketing surveillance databases. METHODS: MEDLINE literature review of sildenafil-associated or amiodarone-associated optic neuropathy and chloramphenicol-associated blood dyscrasias. RESULTS: Sildenafil, amiodarone, and chloramphenicol may all cause adverse ocular events; however, the data are not conclusive. CONCLUSIONS: Reports in peer-reviewed medical journals may be proven incorrect over time. For drug-induced adverse ocular events, there is little true science after the drug reaches the marketplace, so the percentage of incorrect conclusions may be high. Clinicians should be wary of reports of adverse ocular effects until data are confirmed by multiple authors over the long-term. Even so, spontaneous reports from postmarketing surveillance databases may be the first and only signal of an adverse ocular event.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Update on ethambutol optic neuropathy.

Ethambutol optic neuropathy is a well-recognised adverse ocular event in patients who receive ethambutol for the treatment of mycobacterial infections. Much has been published on this condition; however, understanding of patient outcomes and the mechanism by which ethambutol optic neuropathy occurs, as well as data published in textbooks and reference books, tend to lag behind what is currently known. The purpose of this article is to update the clinician on what is currently accepted in regards to the clinical presentation of ethambutol optic neuropathy and what type of eye care should be provided to patients treated with this medication. In addition, new treatment recommendations are suggested to assist clinicians in complying with currently accepted standards of care.

Antitubercular Agents↗
PubMed2005

B-Cells in ocular adnexal lymphoproliferative lesions express B-cell attracting chemokine 1 (CXCL13).

PURPOSE: The homeostatic chemokine, B cell attracting chemokine 1 (CXCL13), has been implicated in the pathogenesis of lymphocyte-mediated diseases. We investigated the cellular expression of this chemokine in the spectrum of ocular adnexal lymphoproliferative lesions. DESIGN: Laboratory investigation. METHODS: CXCL13 expression in paraffin-embedded adnexal biopsy specimens was determined by indirect immunohistochemistry with antigen retrieval. RESULTS: In 15 of 16 biopsy specimens, including reactive lymphoid hyperplasia (n = 7), atypical lymphoid hyperplasia (n = 3), and B cell lymphoma (n = 6), CXCL13 was detected. CD20-positive B-cells, as well as dendritic cells and endothelial cells, expressed the chemokine. CONCLUSIONS: B-cells in ocular adnexal lymphoproliferative lesions demonstrate expression of CXCL13, a chemokine that may participate in tumor pathogenesis and is a potential target for novel therapies.

Antibodies, Monoclonal↗
PubMed2005

Visual side effects associated with erectile dysfunction agents.

PURPOSE: To describe the known ocular side effects of agents used to treat erectile dysfunction. DESIGN: Retrospective observational case series and literature review. METHODS: We reviewed 892 case reports from the National Registry of Drug-Induced Ocular Side Effects (Casey Eye Institute, Portland, Oregon), the Food and Drug Administration (FDA), and the World Health Organization (WHO) and conducted a comprehensive review of the literature. RESULTS: Ocular side effects of these drugs appear fully reversible and transitory. CONCLUSIONS: To date, evidence does not exist to discourage use of erectile dysfunction agents attributable to harmful ocular side effects. Ischemic optic neuropathy (ION) is "possible" by WHO classification, however, conclusive evidence linking ION to erectile dysfunction medications is still lacking.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2005

Pegaptanib for wet macular degeneration.

Pegaptanib sodium injection (Macugen, Eyetech Pharmaceuticals, Pfizer, New York, NY, USA) is a relatively new medication intended to treat the so-called wet (neovascular ) form of age-related macular degeneration (AMD). This form of AMD is characterized by the growth of unwanted new blood vessels into the macula (angiogenesis). The aqueous solution containing pegaptanib is injected into the vitreous of the eye, where it binds to the 165 amino acid isoform of vascular endothelial growth factor (VEGF), a secreted protein that is thought to play a major role in the pathologic angiogenesis that occurs in wet AMD. Neovascular AMD is the leading cause of severe vision loss in people over age 60 in the United States and other industrialized countries (1). Pegaptanib acts as a selective VEGF antagonist through its molecular structure as an aptamer, a pegylated modified oligonucleotide that adopts a three-dimensional configuration, enabling it to bind to extracellular VEGF (Fig. 1). Aptamers are macromolecules composed of chemically synthesized single-stranded nucleic acids (either RNA or DNA) that bind with a high degree of selectivity and affinity when exposed to target proteins. Pegaptanib binds VEGF165, and bound VEGF165 is not able to bind to the VEGF receptor, thereby negating its ability to cause angiogenesis and vascular permeability. Other aptamers exist, as do other forms of treatment for AMD. To date, however, no treatment for AMD has allowed for better vision after treatment, with most surgical treatments leading to almost immediate loss of some vision in the expectation of preventing more severe loss. Research in the field of macular degeneration is advancing rapidly, and treatment with an aptamer such as pegaptanib is a viable option despite the possibility of adverse events.

Age Factors↗
PubMed2005

Ocular side effects associated with dietary supplements and herbal medicines.

Dietary supplements are prevalent worldwide and play a significant role in the treatment of human disease. In the United States, allopathic physicians are at the early stage of learning how to treat patients with natural remedies and other forms of alternative medicine. Elsewhere, however, alternative remedies have been embraced more fully. In Germany, for example, the German Federal Health Agency created Commission E, which has allowed for a more sophisticated approach to assessing the efficacy and safety of dietary supplements and herbal medicines. Health insurance in Germany frequently covers costs for doctor-prescribed herbal remedies. While there is strong evidence that many herbal products have therapeutic effects, there are also a large number of cases of severe adverse reactions due to some of the many thousands of herbal products. One of the first signs of potential toxicity is in the visual system, as in many cases patients notice loss of vision more than systemic side effects. In addition, ophthalmologists are able to detect objective findings through external eye exams and dilated fundus exams. Presented here are some of the more common ocular side effects from frequently prescribed dietary supplements. In most instances, stopping the treatment or decreasing the dose allows for full resolution of symptoms. In addition, comment is made on the regulatory confusion that exists for this industry, especially in the United States.

Dietary Supplements↗
PubMed2004

Ocular side effects from herbal medicines and nutritional supplements.

PURPOSE: To review the more significant herbal and nutritional agents of clinical importance to ophthalmologists and describe the ocular side effects for each. World Health Organization (WHO) classification and guidelines for clinicians are provided. DESIGN: Retrospective observational case series. METHODS: A retrospective observational case series of reports of ocular side effects or systemic side effects from medications used for the eye from herbal medicines and nutritional supplements. Cases were collected from spontaneous reports submitted to the WHO, the Food and Drug Administration, and the National Registry of Drug-Induced Ocular Side Effects. A review of the world's literature was performed to obtain additional case reports and insight into adverse ocular reactions. Data were collected on age, gender, duration of therapy, concomitant medications, dosage, and dechallenge and rechallenge results. RESULTS: The National Registry of Drug-Induced Ocular Side Effects received 263 spontaneous reports, in addition to 60 case reports from the literature. Canthaxanthine, chamomile, Datura, Echinacea purpurea, Ginkgo biloba, licorice, niacin, and vitamin A are all associated with clinically significant ocular side effects. CONCLUSION: Herbal medicines and nutritional supplements can cause ocular side effects. Clinicians need to recognize these adverse events, because a large segment of the population uses them, many times without the treating physician's knowledge.

Adult↗
PubMed2004

Twice-yearly exams unnecessary for patients taking quetiapine.

PURPOSE: To determine the necessity for the heightened level of monitoring for cataract development in patients taking quetiapine (Seroquel, AstraZeneca Pharmaceuticals, Wilmington, Delaware) dictated by the Physicians' Desk Reference. Also, to explore the possibility of cataractogenesis because of quetiapine therapy. DESIGN: Observational case series. METHODS: Data were garnered from a series of 80 case reports collected at the National Registry of Drug-Induced Ocular Side Effects (Portland, Oregon). The World Health Organization (WHO) causality assessment guidelines were used to assess the relationship between quetiapine and cataractogenesis. RESULTS: There were 34 reports of cataracts associated with quetiapine therapy. Average age was 44 years with 23 females and 11 males studied. Average duration of therapy was 29.3 weeks on standard doses. CONCLUSIONS: Cataractogenesis secondary to quetiapine is "unlikely" by WHO guidelines. This probably makes it unnecessary to require biannual ophthalmic examinations as routine eye examinations are sufficient to screen for this condition.

Adolescent↗
PubMed2004

Isotretinoin-associated intracranial hypertension.

PURPOSE: To evaluate the association between intracranial hypertension (IH) and isotretinoin use. DESIGN: Observational case series. METHODS: In this retrospective study, approximately 1950 case reports of adverse ocular side effects related to isotretinoin were received from spontaneous reporting systems. Reports were evaluated as to the occurrence of IH with isotretinoin use. A survey was mailed to all members of the North American Neuro-ophthalmology Society soliciting their opinions on whether isotretinoin caused IH. RESULTS: One hundred seventy-nine reports of IH were associated with isotretinoin use. The mean time from drug exposure to IH diagnosis was 2.3 months. There were 6 cases of positive rechallenge; 5 new cases are reported here, along with 1 previously published report. Of neuro-ophthalmologists surveyed (62% response rate), 6% believed an association between IH and isotretinoin use was certain; 32%, probable; 52%, possible; and 10%, unlikely. Twelve respondents (4%) had personally seen one or more cases of positive rechallenge with isotretinoin causing IH. CONCLUSIONS: Based on the number and pattern of rapid IH onsets after isotretinoin exposure and the 6 cases of positive rechallenge, along with the probable similarity in metabolic pathways of this agent and vitamin A (a known cause of IH), it seems certain that there is a direct correlation between IH and isotretinoin use.

Adolescent↗