Prevalence and Clinical Patterns of Ocular Complications Associated With Anti-PD-1/PD-L1 Anticancer Immunotherapy.

PURPOSE: Immune checkpoint inhibitors (ICI) targeting the programmed cell death protein 1 (PD-1), or its ligand PD-L1, are the mainstay of metastatic cancer treatment. Patients receiving these treatments may develop immune-related adverse events (irAEs). This study aimed to estimate the prevalence and describe the clinical patterns of moderate-to-severe ocular irAEs-associated with anti-PD-(L)1 treatment. DESIGN: Prospective case series. METHODS: This study included patients recruited via (1) a single-center prospective cohort and (2) a national pharmacovigilance registry between June 2014 and March 2018, and focused on patients with moderate-to-severe ocular irAEs following anti-PD-(L)1. All patients underwent a comprehensive ophthalmologic assessment. The main outcome measure was the prevalence of moderate-to-severe ocular irAEs. RESULTS: Of a total of 745 patients included in the prospective cohort, 3 developed moderate-to-severe ocular irAEs, providing a prevalence of 0.4% and an incidence of 0.7 per 1000 patient-months of treatment. An additional 5 cases of moderate-to-severe ocular irAEs were reported through the national registry. From these 8 patients, 5 presented with intraocular inflammation, 2 with ocular surface disease, and 1 with orbital myopathy. Five patients (62.5%) experienced additional extraophthalmologic irAEs. Ocular irAEs led to permanent discontinuation of anti-PD-(L)1 in 4 patients. Treatment by local and/or systemic corticosteroids allowed resolution or control of the ocular symptoms in 7 of 8 patients. CONCLUSION: Although uncommon, anti-PD-(L)1-associated ocular complications may be sight-threatening and lead to discontinuation of anti-PD-(L)1 treatments. Patients complaining of eye problems while receiving ICI treatment should immediately be seen by an ophthalmologist.

Driving and vision disorders / Conduite automobile et troubles de la vision

Driving and vision disorders. Optimal vision is mandatory for safe driving. Many either acute or chronic ophthalmological conditions may unconsciously alter the driver's vision. A sufficient visual function is mandatory to obtain a driver's license, with specific criteria depending on the type of the vehicle and the drivers's occupation. The Decree of 18 December 2015 amending the Decree of 21 December 2005 sets out a list of medical conditions incompatible with a driving license or which may lead to the issuance of driving licenses for a limited period of validity. Every driver must constantly be in both condition and position to perform all the required maneuvers without delay. The occurrence of different ophthalmological conditions throughout life is a key parameter to be considered when improving road safety. The regulation is clear about the procedures to be followed by the drivers but progress is still needed to inform patients about their disability and also the risks incurred by those suffering from ocular diseases. New generation driving simulators and the development of autonomous cars may improve road safety without limiting the autonomy even if the use is only scheduled for 2030.

Conduite automobile et troubles de la vision. Une vision optimale est capitale pour une conduite en toute sécurité. De nombreuses pathologies ophtalmologiques, aiguës ou chroniques, peuvent altérer grandement la fonction visuelle, parfois sans aucune conscience de la part du conducteur. La présence d'une fonction visuelle suffisante est nécessaire à la délivrance du permis, avec des critères spécifiques selon le type de véhicule et de profession. L'arrêté du 18 décembre 2015 modifiant l'arrêté du 21 décembre 2005 fixe la liste des affections médicales incompatibles avec l'obtention ou le maintien du permis de conduire ou pouvant donner lieu à la délivrance de permis de conduire de durée de validité limitée. Tout conducteur de véhicule doit se tenir constamment en état et en position d'exécuter commodément et sans délai toutes les manoeuvres qui lui incombent. La survenue de différentes affections oculaires tout au long de la vie est un paramètre principal à prendre en considération lorsque l'on souhaite renforcer la sécurité routière. La réglementation est claire sur les procédures à suivre, mais des progrès sont nécessaires afin d'informer les patients de leur handicap mais aussi des risques encourus au volant. Les simulateurs de nouvelle génération et la voiture autonome pourraient permettre une amélioration de la sécurité routière sans limiter l'autonomie des personnes déficientes même si l'utilisation n'est prévue qu'à l'horizon 2030.