Differential effects of tamoxifen and anastrozole on optic cup size in breast cancer survivors.
BACKGROUND
The main purpose of this study was to determine whether the optic cups of tamoxifen users and anastrozole users differ in size, with the cups of the tamoxifen users being smaller.


METHODS
Optic nerve head (ONH) topography was measured using a commercially available, confocal scanning laser ophthalmoscope for three populations of amenorrheic women ages 40-69 years: subjects using (1) tamoxifen (20 mg/day) or (2) anastrozole (1 mg/day) for < or = 2 years as adjuvant therapy after successful primary treatment for breast cancer, and (3) control subjects with no breast cancer histories and not using any hormonal medication. All subjects had excellent visual acuity and healthy eyes, based on conventional photographic assessment.


RESULTS
The cup volumes of the tamoxifen users were shown to be significantly smaller than the cup volumes of the anastrozole users, which were indistinguishable from normal. Because the cup volumes of the tamoxifen users decreased markedly with age at about 50 years and because anastrozole is indicated only for post-menopausal women, comparisons were reassessed for subjects older than 50 years. For these subjects, the cup volumes of the tamoxifen users averaged less than half of the volumes for each of the other two subject groups, and significant between-group differences existed in both the lateral (cup area) and axial (cup depth) directions. In contrast, any between-group differences at the ONH margin were small and not significant.


CONCLUSIONS
The results of this study suggest that the ONH be assessed biomorphometrically for tamoxifen users reporting visual change that cannot be attributed to non-tamoxifen causes. The ability of modern intraocular imaging techniques to reveal anatomic change on the order of tens of microns may be useful for assessing tamoxifen-induced effects occurring simultaneously elsewhere in the brain, particularly since the presence of small cups is consistent with the possibility of tamoxifen-induced astrocytic swelling.
Eisner
Alvin
A
Neurological Sciences Institute , Oregon Health & Science University, West Campus, 505 NW 185th Avenue, Portland, OR 97239, USA. eisnera@ohsu.edu
Toomey
Maureen D
MD
Falardeau
Julie
J
Samples
John R
JR
Vetto
John T
JT
D000328:Adult; D000368:Aged; D000568:Amenorrhea; D000077384:Anastrozole; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007834:Lasers; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use*; D009887:Ophthalmoscopy / Q000379:methods; D009898:Optic Disk / Q000187:drug effects* / Q000473:pathology; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*; D015996:Survival Rate; D017741:Survivors; D013629:Tamoxifen / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use*; D014792:Visual Acuity
D047072:Aromatase Inhibitors; D009570:Nitriles; D020845:Selective Estrogen Receptor Modulators; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole