A Prospective Cross-sectional Screening Using Non-mydriatic Fundus Photography and Optical Coherence Tomography in Patients on Tamoxifen Therapy

Purpose: To determine the prevalence of tamoxifen retinopathy and assess the utility of a screening protocol using non-mydriatic fundus photography and optical coherence tomography (OCT).Methods: Between May and October 2024, patients on tamoxifen therapy at a breast surgery clinic were offered screening including non-mydriatic fundus photography and OCT.Among those who consented, 290 patients (580 eyes) were included after excluding other retinal diseases.We investigated tamoxifen duration, cumulative dose, central retinal thickness, BMI, underlying diseases, menopausal status, and history of chemotherapy, hormone therapy, or oral contraceptives.Results: All patients were taking 20 mg of tamoxifen daily.The mean treatment duration was 55.7 29.5 months for those treated longer than two years (n = 193), with a mean BMI of 22.1 3.0 kg/m2.Systemic comorbidities included dyslipidemia (n = 27, 14.0%), hypertension (n = 19, 9.8%), diabetes mellitus (n = 13, 6.7%), and cardiovascular disease (n = 4, 2.1%).Additionally, patient histories included chemotherapy (n = 84, 43.7%), postmenopausal status (n = 56, 29.1%), hormone therapy (n = 52, 27.0%), and oral contraceptive use (n = 14, 7.2%).Tamoxifen retinopathy was not observed in any of the patients.Conclusions: In this cross-sectional study, the prevalence of tamoxifen retinopathy, as assessed by non-mydriatic fundus photography and OCT in this study, was 0%, which is lower than previously reported rates (0.9%-12%).Although specialized examination by an ophthalmologist, including a dilated fundus examination and OCT remains the diagnostic gold standard, practical constraints can limit its routine clinical use.Our study evaluated a screening protocol performed without ophthalmologist intervention.However, we found that limitations in image quality compromised the detection of subtle lesions, such as crystalline deposits.Consequently, this approach may be insufficient to serve as a primary screening strategy.