This 72YO female recently completed a 5-year course of Tamoxifen as adjunctive treatment for breast cancer. She had no visual symptoms with 20/30 vision bilaterally.
Clinically, there were subtle bilateral foveal pigmentary changes. B-scan and en-face OCT showed bilateral cavitary changes.
Learning Points:
Tamoxifen retinopathy shares findings very similar to those of macular telangiectasia type 2 (MacTel2), including retinal cavitations, right-angle venules, and inner retinal crystals. The changes in MacTel2 are usually confined to the temporal fovea, whereas with Tamoxifen, they seem more diffusely distributed throughout the entire central macula. The retinal changes for both disorders likely share Muller cell injury as the underlying cause.
The prevalence of Tamoxifen retinopathy may be as high as 12%. Although most oncologists do not require this, periodic ophthalmic screening, OCT, and examinations may be indicated since patients can lose central vision if toxicity develops.
