Those with multiple myeloma may experience vision problems at some point during treatment. Vision problems can range from blurriness and light sensitivity to swelling, patchy vision, and even infection. However, several factors play a role in developing ocular issues associated with multiple myeloma.

Vision Effects

Multiple Myeloma and Its Effects on Vision

In many cases, multiple myeloma treatments can lead to eye issues. Some potential side effects involve inflammation, cataracts, damage to blood vessels behind the eye, and an increased risk of infections – including conjunctivitis. Each treatment option can affect your vision differently.

Steroids

Drugs like dexamethasone (Decadron) can cause fluid retention, leading to swelling in the back of the eye, according to Frits van Rhee, MD, PhD, professor of medicine and clinical director of the Myeloma Center at the University of Arkansas Medical Sciences in Little Rock.

In a previous interview with Patient Power, Dr. van Rhee also noted that these medications could increase the risk of developing cataracts – cloudiness in the eye’s natural lens. While cataracts are common in those over age 65, they can occur prematurely in those undergoing long-term treatment with steroids.

Proteasome Inhibitors and Immunomodulators

These medications slow the production of cancer cells but can also adversely affect vision. Proteasome Inhibitors like bortezomib (Velcade) can lead to rare side effects, such as posterior reversible encephalopathy syndrome (PRES). PRES is a condition where the small blood vessels in the brain become inflamed. It can cause a sudden decrease in vision, double vision, changes in color vision, or blindness.

Immunomodulators, like lenalidomide (Revlimid), can also cause blurred vision and an increased risk of cataracts, according to clinical trial results. Dr. van Rhee explained that doctors may decide to remove cataracts when the symptoms associated with them become “troublesome.”

Bortezomib can be associated with inflammation of the eyelids known as blepharitis.

Antibody-Drug Conjugates

These drugs target specific cancer proteins. They can also affect vision, though these effects are often reversible. Common ocular side effects include dry eyes, blurred vision, and damage to the cornea – the outermost layer of the eye. An example of an ADC was Belantamab mafodotin (Blenrep), but this is now off market in the United States.

High-Dose Therapy and Stem Cell Transplantation (HDT-SCT)

HDT-SCT is a process in which chemotherapy drugs are used to destroy cancer cells, followed by stem cell transplantation to replace the destroyed cells with healthy ones. This process can cause temporary vision issues associated with cataract development. Dry eye syndrome and irritation may also occur.

Bisphosphonates

This class of drugs, including zoledronic acid (Zometa) and pamidronate (Aredia), slow or prevent the bone destruction associated with multiple myeloma. They have been linked to several adverse effects related to the eyes, including:

  • Pink Eye (conjunctivitis)

  • Inflammation of the scleral tissues (scleritis)

  • Inflammation of the uvea (uveitis)

  • Inflammation of the epischeral tissues (episcleritis)

  • Orbital inflammation

Eye Infections

Multiple Myeloma and Eye Infections

People with multiple myeloma often have a weakened immune system due to both the disease process and treatment plan. This can lead to an increased risk of infections, many of which can affect your vision. These include:

Varicella-zoster Virus (Shingles)

A viral infection that can spread to the eyes, leading to inflammation and vision loss.

Herpes Simplex-1

A virus known for causing cold sores that can also affect the eyes.

Pink Eye (Conjunctivitis)

Inflammation of the conjunctiva that often causes redness and irritation.

Keratitis

Inflammation of the outermost layer of the eye called the cornea.

Uveitis

An inflammation of the uvea, which is the layer inside the eye that includes the iris and choroid.

Blepharitis

Inflammation of the eyelids.

It’s important to monitor your vision closely and contact an ophthalmologist (a doctor specializing in eyes) immediately if you experience signs of infection or inflammation in the eyes.

Symptoms

Symptoms of Vision Problems with Multiple Myeloma

Some of the most common symptoms of vision problems associated with multiple myeloma include:

  • Blurriness

  • Distorted or patchy vision

  • Swollen eyes or feeling pressure behind the eyes

  • Changes in focus

  • Light sensitivity

  • Pain or redness

  • Discharge from the eyes

  • Gritty feeling in the eyes

  • Halo effect around lights

  • Double vision

Managing Vision Problems

Managing Vision Problems in Multiple Myeloma

Vision issues with multiple myeloma are possible; however, there are effective methods of managing them and reducing further complications.

When managing vision problems associated with multiple myeloma, it is best to talk to your doctor. Regular eye exams with an ophthalmologist can help detect any vision changes early on. If treatment-related vision problems occur, your doctor may suggest changes to your treatment plan by reducing the dosage or switching medications, according to Dr. van Rhee.

This article was originally published March 17, 2023 and most recently updated April 11, 2023.
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Lindsay Modglin, Medical Writer:  
David Dingli, MD, PhD, FRCP, FRCPEd, CBiol, FRSB, FRSM, Professor of Medicine, Division of Hematology: