Eye and Vision Changes
The most notable side effect associated with MIRV is eye and vision changes. In fact, MIRV carries a black box warning for serious eye-related problems. A black box warning is the FDA’s strongest safety warning, and is used to call attention to side effects that can become severe or life-threatening if they’re not monitored and treated early.
Nearly 6 in 10 people treated with MIRV experience some form of eye-related side effect. On average, people develop eye symptoms about a month after treatment. Some people notice symptoms within the first few weeks of treatment.
Side effects can include:
- Blurry vision
- Dry or irritated eyes
- Sensitivity to light
- Eye pain
- Corneal changes (changes to the clear outer layer of the eye, often detected during an eye exam before you notice any symptoms)
- Cataracts or worsening of existing cataracts
- Feeling like something is persistently stuck in your eyes
Blurred vision is the most frequently reported symptom, affecting nearly half of patients, followed by corneal changes in about a third, says Miriana Hijaz, MD, a gynecologic oncologist and the division director of gynecologic oncology and women’s health services at Henry Ford Health in Detroit. For the majority of people, symptoms improve or resolve with care.
Managing Eye and Vision Changes
You’ll have an eye exam before your first dose of MIRV, and follow‑up eye exams every other cycle (approximately every six weeks) for the first eight cycles to watch for early changes.
To help lower the risk of eye problems, your care team will usually prescribe steroid eye drops to use the day before each infusion, and for a few days after, along with lubricating artificial tears. Steroid eye drops help reduce eye inflammation, and lubricating tears help keep the eyes moist and reduce irritation.
A few things you can do to prevent and manage vision changes include:
- Use your steroid eye drops and artificial tears exactly as prescribed.
- Avoid wearing contact lenses unless your eye doctor says they’re safe to use during treatment.
- Report any eye or vision symptoms to your oncology team right away.
- Don’t skip your scheduled eye exams, even if your eyes feel fine.
Fortunately, eye and vision side effects of MIRV are usually manageable and reversible with close monitoring and treatment adjustments, says David O’Malley, MD, the director of the division of gynecologic oncology at the Ohio State University Comprehensive Cancer Center in Columbus, Ohio.
If you develop eye and vision symptoms, your care team may pause treatment or space infusions farther apart until they improve. Treatment rarely needs to be stopped permanently, and there have, so far, been no reports of permanent vision loss or blindness, Dr. O’Malley says. Regular follow-up care helps your care team respond quickly if changes develop.
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