Neuro-ophthalmic Complications of Immune Checkpoint Inhibitor Therapy for Cancer: Lessons Learned through Case Reports and Big Data

Dr Lynn K. Gordon

Meeting:  2022 RANZCO


Date:      -


Session Time:      -

Synopsis: Treatment of specific cancers was revolutionised through the use of immune checkpoint blockade (ICI) which unleashes the body’s own immune surveillance and mechanisms to kill tumor cells. This innovative treatment strategy induces remission for many patients with treatment-resistant cancers. Unintended conse- quences of ICI result from disrupting tolerance, there- fore creating autoimmune consequences which can affect the eye and central nervous system. Following ICI therapy, case reports and series document dry eye, uve- itis and multiple neuro-ophthalmic complications involving the optic nerve, cranial nerves, neuromuscular junction and extraocular muscles. The majority of patients with uveitis or optic nerve disease respond to discontinuing the ICI or to systemic or local corticoste- roid therapy. Clinical improvement is however variable for patients with other types of neuro-ophthalmic sequelae. Case series provide insights about specific dis- ease sequelae but do not help us understand the inci- dence or prevalence of complications following ICI therapy. Two big data studies provide additional com- plementary information, one using the IRIS database developed by the American Academy of Ophthalmol- ogy, and the other using the Kaiser Permanent Medical Record system. Using big data, cancer patients were identified to have a higher rate of uveitis and neuro- ophthalmic disease, even without the use of ICI. Patients with a prior history of immune-mediated ocular disease, uveitis or other, had a higher rate of recurrent disease following ICI therapy. Coordination of care between ophthalmologists and oncologists is suggested for patients in which ICI therapy is indicated.