Ocular Toxicity Assessment in Tamoxifen Therapy

Tamoxifen remains a cornerstone of adjuvant endocrine treatment for hormone receptor-positive breast cancer, but its potential for retinal and macular injury has become an area of growing scrutiny. Manifestations range from subtle photoreceptor and retinal pigment epithelium alterations to overt crystalline retinopathy, macular oedema and macular telangiectasia-like changes. Assessment relies on a multimodal imaging approach including funduscopy, optical coherence tomography and, in select cases, adaptive optics scanning laser ophthalmoscopy or angiography. Epidemiological studies have revealed a dose- and duration-dependent risk, with advanced age and co-existing systemic disease amplifying susceptibility. Emerging consensus advocates for baseline ophthalmic examination prior to tamoxifen initiation and periodic monitoring tailored to cumulative exposure, yet screening protocols remain heterogeneous. Improved understanding of pathophysiological mechanisms and standardised surveillance strategies is essential to mitigate visual morbidity without compromising oncological benefit.

Research from Nature Portfolio

A nationwide cohort study of over 14 000 tamoxifen users in South Korea has quantified the incidence and predictors of macular disease. Overall maculopathy occurred in more than one quarter of patients, with rates rising in parallel with age and cumulative drug exposure. Multivariate models identified advanced age, high cumulative dose and underlying liver disease as independent risk factors for both common and atypical maculopathies. Hazard analyses further confirmed age as the most potent predictor of incident macular pathology. These findings offer an evidence base for refined screening guidelines, emphasising early and targeted ophthalmic surveillance in high-risk subgroups.

Ocular Toxicity Assessment in Tamoxifen Therapy publication trend

The graph below shows the total number of articles in ocular toxicity assessment in tamoxifen therapy across all publications each year (not limited to Nature Index journals).

Technical terms

Maculopathy: Degenerative or pathological changes localized to the macula, causing central visual distortion or loss.

Retinopathy: Any disease of the retinal tissue characterised by structural or vascular abnormalities affecting vision.

Optical coherence tomography (OCT): Non-invasive imaging that provides high-resolution cross-sectional views of retinal layers.

Optical coherence tomography angiography (OCTA): Dye-free technique for mapping retinal and choroidal microvasculature by detecting motion contrast.

Cystoid macular oedema (CME): Accumulation of fluid in cystic spaces within the macula, leading to blurred or distorted central vision.

References

1. Drug exposure and risk factors of maculopathy in tamoxifen users. Scientific Reports (2024).
2. Unilateral Tamoxifen-Induced Retinopathy as a Consequence of Breast Cancer Treatment—Multimodal Imaging Value. Diagnostics (2023).
3. Foveal cone loss in tamoxifen maculopathy: a case report. Journal of Medical Case Reports (2023).
4. Nationwide Screening Practices for Tamoxifen Retinal Toxicity in South Korea: A Population-Based Cohort Study. Journal of Clinical Medicine (2024).