Ocular Side Effects

Myeloma and myeloma treatment can lead to changes that affect the eyes (ocular toxicity) ranging from how well a person can see (visual acuity) to tissue damage (i.e. corneal, retinal). Often, these changes are temporary, may continue until treatment is received, or may only occur while on a specific treatment. However, these changes can impact activities of daily living, alter your quality of life, and may lead to discontinuing treatment.

How Multiple Myeloma Affects Eye Health

Hyperviscosity syndrome 

One of the most common eye-related complications of multiple myeloma is hyperviscosity syndrome. This condition occurs when the abnormal plasma cells produce excessive amounts of monoclonal proteins (M proteins), which thicken the blood. Increased blood viscosity can slow down blood flow in the small blood vessels of the retina, leading to various eye problems such as:

• blurred vision
• difficulty focusing
• blind spots
• retinal hemorrhages (bleeding in the retina)
• retinal detachment

Myeloma Disease Burden and Eye Health

Another way multiple myeloma can affect the eyes is through direct infiltration of the abnormal plasma cells into the orbit (the bony cavity that contains the eyeball) or the soft tissues around the eye. This can cause the following:

• proptosis (bulging of the eye)
• diplopia (double vision)
• pain or discomfort in the eye
• eyelid swelling
• decreased eye mobility

In rare cases, multiple myeloma can also lead to optic nerve compression, which occurs when the abnormal plasma cells or the associated bone lesions put pressure on the optic nerve. This can result in the following:

• decreased visual acuity
• visual field defects
• color vision abnormalities

It is important to note that while these eye-related complications may occur in multiple myeloma patients, not all patients may experience them.

Ocular Side Effects of Multiple Myeloma Treatments

• Corneal damage: Certain chemotherapy drugs, such as Blenrep (belantamab mafodotin), can cause damage to the cornea (keratopathy), leading to eye pain, irritation, and vision changes. Although less common, there are reports of Velcade®(bortezomib) and Kyprolis® (carfilzomib) causing ocular changes to the surrounding tissues of the eye. 
• Dry eyes: Chemotherapy and stem cell transplantation can decrease tear production, resulting in dry, itchy, and irritated eyes.
• Cataracts: Long-term use of corticosteroids, such as dexamethasone, can increase the risk of developing cataracts.
• Glaucoma: Corticosteroids can also raise the risk of developing glaucoma, a condition that damages the optic nerve due to increased eye pressure.
• Eye infections: Multiple myeloma and its treatments can weaken the immune system, making patients more susceptible to eye infections like conjunctivitis.

It is essential for patients undergoing multiple myeloma treatment to have regular eye exams. Any vision changes and eye discomfort should be reported to a patient's health provider. In some cases, early detection and management of ocular side effects can help prevent permanent vision loss.
 

A Closer Look: Monitoring Your Eye Health

Regular eye check-ups and prompt reporting of any visual disturbances to healthcare providers are essential. Additionally, managing the underlying multiple myeloma through chemotherapy, stem cell transplantation, and supportive care is crucial for preventing and treating eye-related complications. Close collaboration between the patient, hematologist, and ophthalmologist is essential for the early detection and effective management of these issues.