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Show ] oumal of Clinical Nellrv- ophthal/ llology 8( 1): 29, 1988. Editorial Comment Amiodarone Optic Neuropathy ( 1988 Raven Press, Ltd., ~ e\\' York This paper adds another case report to the series of patients who developed optic neuropathy while on amiodarone ( Cardarone, Wyeth Laboratories, Philadelphia, PA). In every respect the patient is comparable with our series, but of course, the paper does not answer the etiology question: Do these high- risk patients have a predisposition to ischemic optic neuropathy on their own, or is the amiodarone adding to this? One must remember that of all these amiodarone- treated patients are under much closer scrutiny than are other patients with similar cardiac arrhythmia problems treated by other means. It is just a fact of life that no controlled series of patients was studied in such a detailed prospective fashion to establish baselines, The proved efficacy of this life- saving medication in controlling arrhythmias is undeniable, and it would simply be unethical to go back and restudy a group of patients for the incidence of optic neuropathy without amiodarone to control their rhythm problems. Nonetheless, if we accumulate sufficient numbers of cases like this, we may be forced by circumstantial evidence to accept the association of optic neuropathy with amiodarone treatment as being more than chance alone. Incidentally, since the publication of our paper, we have had no further cases of optic neuropathy among our series of treated patients. Brian R. Younge, M. D, Mayo Clinic Rochester, Minnesota 55905 29 Addendum: Dr. Younge and associates have just reported a series of 13 patients with optic neuropathy in association with amiodarone therapy. ( Feiner LA, Younge BR, Kazmier FG, Stricker BMC, Fraunfelder FT, Optic neuropathy and amiodarone therapy. Mayo Clill Proc 1987; 62: 70217), We therefore invited Dr. Younge to write an editorial comment about the paper of Nazarian and Jay, and Dr, Younge was too modest to include his pertinent reference so we have added it for him. The " take home message" to the clinician is that just as we need to remember to ask every patient presenting with suspected myasthenia gravis whether or not they have been taking penicillamine- and just as we must ask every patient with ocular inflammation, optic neuritis, Bell's palsy, or lymphocytic meningitis whether or not they were ever bitten by a tick- we now need to remember to ask every patient presenting with ischemic optic neuropathy whether or not they have been taing Cardarone ( amiodarone). History taking becomes even more important in practice I J, L Smith, M. D. |
