The clinical management of patients on antibody drug conjugates

In an exclusive interview with Optometry Times, Jessica Steen, OD, FAAO, DipABO, discussed the emerging and increasingly important role of optometrists in managing patients receiving antibody-drug conjugates (ADCs), a rapidly expanding class of cancer therapeutics. Steen emphasized that these patients are now appearing more frequently in optometric practice, which places new demands on eye care providers to understand both the systemic therapy and its ophthalmic implications.

A key point is that each ADC can have distinct ophthalmic monitoring needs and management protocols. These protocols may go well beyond simple preservative-free artificial tears and can include structured steroid regimens or vasoconstrictor protocols, depending on the specific agent and toxicity profile. Because of this variability, it can be challenging for optometrists to keep the details of each drug and its corresponding eye-care expectations organized and correctly implemented.

Steen underscored that, with growing experience, optometrists are becoming more comfortable not only in clinical management of these patients but also in appreciating the critical importance of formal ophthalmic monitoring as part of oncology care. Working with oncology teams has highlighted how different and specialized each discipline is, and how important it is for optometrists to recognize the unique value of their own specialty knowledge. They are encouraged to be confident in making and communicating ophthalmic recommendations directly to oncologists, who may be unfamiliar with the nuances of ADC-related ocular complications despite their deep expertise in systemic cancer care.

To structure this collaboration, Steen proposed a simple 4-part clinical communication framework:

1. Situation: Where is the patient right now? What are you seeing at this visit?
2. Background: Systemic and ocular history, including medication exposure and prior ophthalmic issues.
3. Assessment: Clinical findings and how they relate to the systemic agent in question.
4. Recommendation: Clear, actionable guidance for ongoing ophthalmic management or modification of therapy.

Sticking to this framework helps optometrists communicate efficiently and effectively with oncologists, supporting a true interdisciplinary partnership in a domain where optometry has not traditionally been heavily involved.