title: Active surveillance of visual impairment due to adverse drug reactions: findings from a national study in the United Kingdom.
abstract: As visual impairment (VI) due to adverse drug reactions (ADR) is rare in adults and children, there is an incomplete evidence base to inform guidance for screening and for counseling patients on the potential risks of medications. We report on suspected drugs and the eye conditions found in a national study of incidence of diagnosis of visual impairment due to suspected ADR. Case ascertainment was via the British Ophthalmological Surveillance Unit (BOSU), between March 2010 and February 2012, with follow-up after 6 months.
  
  
  METHODS
  any child or adult with bilateral or unilateral visual impairment due to a suspected ADR, using distance acuity worse than Snellen 6/18 (logMAR 0.48) in the better eye (bilateral) or affected eye (unilateral). Anonymized patient information on potential cases was provided by managing ophthalmologists, comprising visual status before and after suspected ADR, ophthalmic condition attributable to the ADR, preexisting eye disease and prescribed medications at the time of the ADR. Permanency and causality of the visual impairment were confirmed by the managing clinician, after 6 months, using the WHO Uppsala Monitoring Committee criteria. Over 2 years, 36 eligible cases were reported of whom 23 had permanent VI. While most cases were due to drugs known to have adverse side-effects, some were unanticipated sporadic cases. Visual impairment due to ADRs is rare. However, with for example, increasing polypharmacy in the elderly, monitoring of ocular ADRs, although challenging, is necessary.
authors.affiliation: Life Course Epidemiology and Biostatistics Section, University College London (UCL) Institute of Child Health London, United Kingdom ; Ulverscroft Vision Research Group London, United Kingdom.
authors.forename: Phillippa M
authors.initials: PM
authors.lastname: Cumberland
authors.affiliation: Ulverscroft Vision Research Group London, United Kingdom ; Great Ormond Street Hospital for Children NHS Foundation Trust London, United Kingdom.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Russell-Eggitt
authors.affiliation: Life Course Epidemiology and Biostatistics Section, University College London (UCL) Institute of Child Health London, United Kingdom ; Ulverscroft Vision Research Group London, United Kingdom ; Great Ormond Street Hospital for Children NHS Foundation Trust London, United Kingdom ; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology London, United Kingdom.
authors.forename: Jugnoo S
authors.initials: JS
authors.lastname: Rahi
keywords: Active surveillance; adverse drug reactions; ocular; pharmacoepidemiology; visual impairment