Vision loss in pHTN patient

Q: 44 years old female with underlying pulmonary hypertension (pHTN), recently discharged from the hospital, presented back to the ED with vision loss in one eye. Emergent ophthalmic consult is obtained. The patient is found to have serious retinal detachment (SRD). Which drug could be a culprit?

Answer: Phosphodiesterase 5 Inhibitors (PDE5) inhibitor 

Minor vision issues with PDE5 inhibitors are well known, such as blue vision (cyanopsia) with sildenafil, which occurs due to a cross-reaction with the PDE6 inhibitor in the retina. Interestingly, cyanopsia has not been reported with vardenafil, tadalafil, or avanafil.

Major serious eye effects are not common but can be devastating, such as nonarteritic anterior ischemic optic neuropathy (NAION), serious retinal detachment (SRD), and retinal vein occlusion (RVO), particularly in patients who are already at high risk, such as older age, HTN, dyslipidemia, and diabetes. 

# ophthalmology

#pulmonary

References:

1. Etminan M, Sodhi M, Mikelberg FS, Maberley D. Risk of Ocular Adverse Events Associated With Use of Phosphodiesterase 5 Inhibitors in Men in the US. JAMA Ophthalmol 2022; 140:480.

2. Barroso F, Ribeiro JC, Miranda EP. Phosphodiesterase Type 5 Inhibitors and Visual Side Effects: A Narrative Review. J Ophthalmic Vis Res. 2021 Apr 29;16(2):248-259. doi: 10.18502/jovr.v16i2.9088. PMID: 34055262; PMCID: PMC8126729.

3. Moschos MM, Nitoda E. Pathophysiology of visual disorders induced by phosphodiesterase inhibitors in the treatment of erectile dysfunction. Drug Des Devel Ther. 2016 Oct 19;8:3407-3413. doi: 10.2147/DDDT.S118015. PMID: 27799745; PMCID: PMC5076796.