As optometrists, it is important that we are aware of the possible ocular complications that can occur from the use of high risk medications.
Patients starting fingolimod (Gilenya) for multiple sclerosis need to be screened for fingolimod-associated macular edema (FAME). This should be done before the patient starts the medication and repeated three to four months later, as most cases of FAME have been shown to occur during this time period.1
If no FAME is present at this time, a follow-up exam at six months and then annually are advisable. At a higher risk of FAME, are patients with a history of uveitis or diabetes.2
Recommended Screening:
- Complete ocular health examination including a dilated retinal assessment
- Concern: Preexisting retinal disease
- Spectral domain OCT of the macula
- Concern: Baseline macular integrity analysis as well as objective measurement for macular edema
- Amsler grid
- Concern: Macular integrity assessment when OCT is not readily available
It's critical to educate your patients on the risk of macular edema and the importance of screening while on fingolimod. Home amsler grid monitoring is often an advisable and effective tool.
If early changes and/or macular edema are detected, consult with your patient's prescribing doctor immediately. Unlike hydroxychloroquine maculopathy, macular damage is often reversible upon discontinuation of fingolimod.
References:
- Kappos L, Radue EW, O’Connor P, et al. A placebo controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010 Feb 4;362(5):387-401.
- Jain N, Bhatti MT. Fingolimod-associated macular edema: incidence detection and management. Neurology. 2012 Feb 28;78(9):672-80.
