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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2286
Experience:  Eye Physician and Surgeon
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My husband is having vision problems after CHOP-R chemo

Resolved Question:

My husband is having vision problems after CHOP-R chemo treatments for non hodgkins lymphoma. He's also had intrathecal methotrexate and radiation. Wondering if the vision problem is temporary. Could it be caused by the treatment or the disease?

Debbie Smith
Submitted: 8 years ago.
Category: Eye
Expert:  Dr. James replied 8 years ago.
Where was the radiation? How long ago was the chemotherapy? What vision changes is he reporting and when did those start?
Customer: replied 8 years ago.
Testicles radiation. Chop Completed begining of June (6/6/09). Intrathecal methotrexate 3.5 weeks ago. Light seems diminished. Doesn't see things ,then they come into view. diminished peripheral.
Expert:  Dr. James replied 8 years ago.
Hi Debbie,

Thank you for the additional information. It is very helpful.

There are 3 possibility for his vision loss.

1) Cancer associated retinopathy - This is a retinal degeneration caused by a cross-reactivity with certain cancers and they eye. This is common associated with lung cancers. In the early stages, it may be difficult to tell on exam, but there are specialized testing of electrical activity of the brain that can differentiate it (ERG - electroretinogram).

2) Optic nerve damage from the intrathecal methorexate - The optic nerve carries the signals from the eye to the brain. The optic nerve could have been damaged due to direct contact with the chemotherapy drugs (methotrexate).

3) Damage to the visual pathways - The signals go through the nerve, then back to different pathways and finally to the part of the brain that process the information. Possibly, the lymphoma could have damage part of this pathway. This usually causes a focal visual field defect, such as not seeing half of the vision or only a quarter of the visual field.

I believe he needs to be examined by an ophthalmologist. He will check his current vision and assess the function of the optic nerve. Likely perform an automated visual field test and look in the back.

I suspect it could to optic nerve damage from the methotrexate. It that is the case, then you will need to discuss with your oncologist regarding risk/benefits of continuing it. Treatment for #1 is the treat the underlying cancer. For #3, CT scan may help to visualize any masses that could be affecting the visual pathways.

Remember to press the accept button. It was a pleasure helping you with your question today. I wish the best for you and your husband and continued strength to help you through this. Feel free to ask any additional questions.
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