The Optometrist’s Role in Breast Cancer Treatment & Management

October is breast cancer awareness month. Women with a history of breast cancer are routinely checked with

Dr. Maria Richman (far right) with the NJSOP staff at the Breast Cancer 3-day walk in 2009

mammograms and ultrasounds but they should also routinely visit their optometrist.

Breast cancer is the most common malignancy in women. The incidence of breast cancer is increasing especially in developed world. It is classified as the second most frequent cause of death in women, after lung cancer. Better screening, earlier detection, and better treatment modalities have positively altered the prognosis and survival time of patients suffering from breast cancer.

Despite recent advances in early diagnosis and effective treatment, it is estimated that up to one-third of patients having been diagnosed with breast cancer will develop metastatic disease. Because early diagnosis and prompt management may positively alter the prognosis for these patients, optometrists should be aware of this entity.

A comprehensive dilated eye exam should not be overlooked in the breast cancer population. Some forms of breast cancers can metastasize to the eye. An optometrist can detected much through a dilated retinal exam, including any tumors or vascular abnormalities. If a metastasis is discovered, the patient would be referred to an ocular oncologist who would work closely with the general oncologist.

Ocular metastases of breast cancer, although rare, can occur in both male and female patients, and in women breast is the most common site of origin of ocular metastatic tumors, since, in 49% of patients with ocular metastatic disease, the primary tumor origin was the breast. This subsequently leads to an increased variety of ocular manifestations and problems associated with patients’ vision that are likely to require optometric consultation and management.

Additionally, many breast cancer patients are prescribed systemic treatment including hormone therapy, specifically selective estrogen receptor modulator (tamoxifen), aromatase inhibitors (anastrozole, letrozole, and exemestane), cytotoxic chemotherapy, or targeted therapy with monoclonal antibodies (trastuzumab).

When patients are undergoing chemotherapy or any of the hormone therapies, most of the drugs cause dry eye symptoms. The optometrist can treat dry eye disease with an artificial tear regiment, prescription medicines or certain procedures. Additionally, possible side effect of one of the most prevalent medications, Tamoxifen, is increased risk of cataracts and a possible side effect of Arimidex is low tension glaucoma.

At the appointment, the eye doctor needs to know that the medical health has changed when a person is diagnosed with breast cancer. The medicines taken and the procedures received also need to be brought to the optometrist’s attention. Remember, the optometrist is a team player in everyone’s health management.

Maria Richman, OD, FAAO

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