(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York
Subject
Pharmaceutical Side Effects; Bilateral NAION; Amiodarone
Description
Dr. Lee lectures medical students on the subject of Amiodarone and its impact on neuro-ophthalmological health.
Transcript
"Amiodarone optic neuropathy. And Amiodarone is an antiarrhythmic. It definitely saves lives. it's a really important drug to Cardiology. So you need to be looking out for it in the med list because it can produce vision loss, and the way it does it is it looks exactly like Non-Arteritic Anterior Ischemic Optic Neuropathy. Now there's some clues that maybe it's not garden variety NAION because oftentimes it's bilateral, or it's rapidly sequential. For example, it goes right from the right eye to the left eye real fast. We're going to be looking at the cornea because the thing that we're going to be looking for on the cornea is a vortex keratopathy, a corneal verticillate, a pigmented brown deposition of the drug Amiodarone right in the cornea, and it's usually right here inferiorly. So when we see a patient who is on Amiodarone and has decreased vision or visual field, and we have an RAPD if it's ipsilateral and unilateral, we're going to be looking for that disk edema. And if it's bilateral or rapidly sequential, that is highly suggestive that it's Amiodarone. It normally long duration, it takes a long time for it to go away and the Amiodarone's half-life is relatively long and so it can stick around for months, maybe an entire year. So even if you stop the drug, they can keep losing their vision. And so before you make the diagnosis of Amiodarone, even if they're on it and you see the vortex, you have to do an MRI and a spinal tap and look for all the other causes of optic neuropathy, because there's no tests to prove it's Amiodarone. And even if you stop the drug they might keep getting worse. And so you need to know a little bit about Amiodarone optic neuropathy. You have to call cardiology or the prescribing doctors to make sure that they're okay with stopping it. I would not recommend stopping the medicine. Usually there's two answers when we get this Amiodarone optic neuropathy from the prescribing doc: either number one sure just stop it, or number two he'll die without it. So you really can't be making that call on your own. So we really need to be involved everybody, and obviously this could end up in litigation and so you got to be careful with these Amiodarone cases. And so prescribing and documenting the risks and benefits with the patient and the other doctor as well as discussions with the prescribing doctor all have to be documented well in the chart."
