Adverse Drug Reactions in Ophthalmology - are they a Myth?

Abstract

Sometimes ocular (and systemic) therapeutics may cause ocular (and systemic) diseases, namely adverse drug reactions (ADRs). The Journal of Ocular Diseases and Therapeutics is therefore doubly adequate for discussion of the theme of ADRs in Ophthalmology. Many terms are utilized as synonyms but the correct definition of ADR (according to the World Health Organization, WHO) is: "any noxious, unintended and undesired effect of a drug, which occurs at doses used in humans for prophylaxis, diagnosis, or therapy". Ophthalmology is one of the medical specialties in which there is a high difficulty in continuous diagnosis, assessment and treatment. Additionally, the specific and delicate anatomy and physiology of the eye may easily be disrupted by an ADR, with possible irreversible consequences. Ocular ADRs may be frequent (such as cornea verticillata caused by amiodarone) or specific. On the other hand, systemic ADRs may occur after ocular treatments (such as hypotension after instillation of a beta-blocker drop). The timely detection and recognition of ADRs is therefore critical. Several methods exist for the detection of ADRs, but few are specific or apply to ADRs in Ophthalmology. Spontaneous reporting is a low-resource method for detection of ADRs but has flaws, namely under-detection and risk of bias. The literature can be confusing or incomplete, with several case reports and case series about ocular ADRs lacking a causality assessment (such as Naranjo's or WHO's). In conclusion, ADRs in Ophthalmology are a heterogeneous group of ADRs that lack detection, assessment and systematization. Studies about ADRs should increase their quality for further clarification. Each ophthalmologist should know the specific ocular ADRs to systemic medication, the specific systemic ADRs to ocular medication, and to detect and treat them adequately for good clinical practice.