AOA 2026: Managing ocular toxicities in patients with cancer

Mile Brujic, OD, FAAO, provides an overview of ocular toxicities associated with antibody–drug conjugates (ADCs), a relatively new class of targeted cancer therapies. He explained that ADCs consist of an antibody directed against a specific antigen on tumor cells, coupled with a cytotoxic “payload.” The intent is to achieve high specificity for cancer cells, improving efficacy and limiting systemic toxicity. Despite this targeted approach, distinctive ocular side effects have emerged, making eye care involvement essential.

Brujic noted that ADC-related ocular adverse events can include microcystic epithelial changes, corneal staining, and refractive shifts. Because these treatments are often used as a later-line or “last resort” therapy for certain cancers, patients may be reluctant to report visual symptoms for fear that their oncologist will discontinue treatment. This dynamic underscores the importance of building trust and encouraging honest symptom reporting in the eye care setting.

Fortunately, patients receiving ADCs are usually pre-identified and pre-specified for ophthalmic monitoring due to a black box warning on these agents. Protocols require a comprehensive eye examination before the first infusion, followed by evaluations every 6 weeks for the first 6 months. However, Brujic emphasized that patients must also be instructed to seek care between scheduled visits if they notice any visual changes or ocular discomfort.

Effective care depends on structured communication between optometrists/ophthalmologists and oncologists. Brujic describes using standardized forms—available online and accessible via QR codes—that document visual acuity and ocular surface status at each visit. Sending these forms to the oncology team consistently is “critically important” for coordinated management.

Educational gaps remain in eye care regarding standardized protocols for managing ADC-related ocular effects. Brujic outlined a specific prophylactic regimen: beginning one day prior to each ADC infusion, patients use a topical corticosteroid drop 6 times daily for 4 days, then 4 times daily for the next four days—an 8-day corticosteroid pulse repeated with every infusion (typically every 3 weeks). Proper prescribing, patient education, and adherence to this regimen can mitigate ocular symptoms.

Brujic concluded by stressing that as the number and use of ADCs expand, eye care providers must understand their ocular side effects, treatment protocols, and the necessity of active, ongoing communication with oncology to optimize patient care.