Regular Ophthalmic Examination of Patients Taking Ethambutol

Jeong Hyun Lee; Sang Bong Choi; Jin Choi

doi:10.3341/jkos.2016.57.12.1939

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Lee, Choi, and Choi: Regular Ophthalmic Examination of Patients Taking Ethambutol

Original Article

J Korean Ophthalmol Soc 2016;57(12):1939-1945.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.12.1939

Regular Ophthalmic Examination of Patients Taking Ethambutol

Jeong Hyun Lee, MD¹, Sang Bong Choi, MD, PhD², Jin Choi, MD, PhD¹

¹Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

²Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

Address reprint requests to Jin Choi, MD, PhD Department of Ophthalmology, Inje University Sanggye Paik Hospital, #1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: 82-2-950-1096, Fax: 82-2-935-6904 E-mail: sylvia8@hanmail.net

Received 18 August 2016 Revised 21 September 2016 Accepted 16 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

In the present study, regular ophthalmic examinations performed in patients taking ethambutol were analyzed and the risk factors for ethambutol optic neuropathy were investigated.

Methods

We retrospectively collected the data of patients diagnosed with tuberculosis at Inje University Sanggye Paik Hospital and referred to the Department of Ophthalmology between October, 2010 and June, 2015. The patients were divided into three groups: group A (patients without visual loss), group B (patients with visual loss who were not diagnosed with ethambutol optic neuropathy), and group C (patients with visual loss who were diagnosed with ethambutol optic neuropathy). We evaluated each patient's glomerular filtration rate, ethambutol daily dosage, duration of ethambutol prescription, change in best corrected visual acuity, Ishihara color test over time, and peripapillary retinal nerve fiber layer thickness based on optical coherence tomography and mean deviation of perimetry.

Results

Group A consisted of 158 patients (86.8%), group B of 12 patients (6.6%), and group C of 12 patients (6.6%). Age was a risk factor for ethambutol optic neuropathy according to logistic regression analysis (p < 0.001) with a cutoff value of 59.5. In group B, visual acuity showed significant difference (p < 0.001) and in group C, visual acuity (p < 0.001) and color vision (p < 0.001) showed significant differences before and after taking ethambutol. When comparing groups B and C, average and temporal thickness of peripapillary retinal nerve fiber layer were not significantly different but mean deviation of perimetry was significantly different (p = 0.010).

Conclusions

Elderly patients should be more cautious when taking ethambutol, and color vision test and perimetry are useful diagnostic tools to differentiate patients with ethambutol optic neuropathy from patients with simple visual loss.

Keywords: Color test, Ethambutol, Optical coherence tomography, Perimetry, Visual acuity

References

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Figure 1.

Receiver operating characteristic (ROC) curve showing the sensitivity and specificity of the age. Area under cover value of age was 0.792 (p = 0.001).

Table 1.

Demographics of patients in each group

	A (158)	B (12)	C (12)	p-value	Total (182)
Sex (M/F) (n, %)	85 (54)/73 (46)	8 (67)/4 (33)	4 (33)/8 (67)	0.376^*	98 (54)/84 (46)
Age (year)	48.23 ± 19.06	56.06 ± 16.10	70.63 ± 17.44	<0.001^†	51.01 ± 19.28
BCVA (log MAR)	0.12 ± 0.22	0.17 ± 0.22	0.35 ± 0.20	<0.001^†	0.13 ± 0.23
Tonometer (mm Hg)	11.97 ± 2.88	11.00 ± 3.26	10.63 ± 3.59	0.077^†	11.81 ± 2.96
Color test (Isihara)	23.97 ± 0.22	21.92 ± 7.72	21.96 ± 6.15	0.068^†	23.70 ± 4.45
Past history (n, %)
DM	14 (8.9)	5 (41.7)	3 (25.0)	0.065^*	24 (13.2)
HTN	20 (12.7)	7 (58.3)	4 (33.3)	0.127^*	31 (17.0)
Renal disease	2 (1.3)	1 (8.3)	1 (8.3)	0.057^*	4 (2.2)
Ocular history (eyes, %)
None	266 (84.2)	11 (45.8)	10 (41.7)		287 (78.9)
DR	16 (5.1)	7 (29.2)	0 (0)		23 (6.3)
Glaucoma	9 (2.9)	3 (12.5)	4 (16.7)		18 (5.0)
Cataract	9 (2.9)	3 (12.5)	1 (4.2)		13 (3.6)
ARMD	2 (0.6)	0 (0)	2 (8.3)		4 (1.1)
Etc	14 (4.4)	0 (0)	3 (12.5)		19 (5.2)
GFR (mL/min)	94.25 ± 24.70	90.89 ± 28.86	81.81 ± 27.43	0.046^†	93.21 ± 25.21
EMB dosage(mg/d/kg)	14.96 ± 1.71	15.19 ± 1.91	15.05 ± 2.78	0.582^†	14.93 ± 2.13
EMB duration (mon)	7.75 ± 4.95	8.44 ± 3.49	5.40 ± 6.89	0.007^†	7.67 ± 4.99
Follow up time (mon)	6.02 ± 4.95	4.16 ± 2.49	8.20 ± 7.63	0.439^†	6.04 ± 6.70

All values are presented as mean ± standard deviation except for sex and past history. M = male; F = female; BCVA = best corrected visual acuity; log MAR = logarithm of minimal angle resolution; DM = diabetes mellitus; HTN = hypertension; DR = diabetic retinopathy; ARMD = age related macular degeneration; GFR = glomerular filtration rate; EMB = ethambutol; n = number of patients; d = day; mon = month.

^* Linear by linear association

^† Kruskal-Wallis test.

Table 2.

Analysis of possible factors contributing to ethambutol optic neuropathy (adjusted for variables listed in this table)

Variables	Adjusted odds ratio	95% confidence interval		p-value^*
Variables	Adjusted odds ratio	Lower	Upper	p-value^*
Age	1.07	1.02	1.11	<0.001
Sex	0.28	0.06	1.46	0.130
HTN	0.710	0.12	4.10	0.699
DM	2.41	0.45	13.05	0.307
Renal disease	23.71	0.59	961.87	0.094
GFR (mL/min)	1.01	0.99	1.04	0.364
EMB dosage (mg/d/kg)	0.93	0.62	1.39	0.725
EMB duration (mon)	0.10	0.99	1.00	0.245

HTN = hypertension; DM = diabetes mellitus; GFR = glomerular filtration rate; min = minute; EMB = ethambutol; d = day; mon = month.

^* Logistic regression analysis.

Table 3.

Comparison of BCVA and color test in each group

	BCVA (log MAR)			Color test (Isihara)
	Initial	Final	p-value	Initial	Final	p-value
A	0.12 ± 0.22	0.12 ± 0.23	0.445^*	23.97 ± 0.22	24.03 ± 0.22	0.690^*
B	0.17 ± 0.22	0.49 ± 0.61	<0.001^†	21.92 ± 7.72	21.83 ± 1.57	0.163^†
C	0.35 ± 0.20	0.75 ± 0.50	<0.001^†	21.96 ± 6.15	16.42 ± 9.12	<0.001^†

All values are presented as mean ± standard deviation. BCVA = best corrected visual acuity; log MAR = logarithm of minimal angle resolution.

^* Paired t-test

^† Wilcoxon signed rank test.

Table 4.

Comparison of visual field test and RNFL thickness between group B and group C

Average pRNFLT	No. of eyes 12	B 82.50 ± 12.01	No of eyes 16	C 92.88 ± 13.38	p-value 0.246^*
Temporal pRNFLT	12	74.75 ± 10.81	16	76.75 ± 18.45	0.580^†
MD of perimetry	12	–4.92 ± 2.35	16	–8.81 ± 9.00	0.010^†

All values are presented as mean ± standard deviation. RNFL = retinal nerve fiber layer; No. = number; pRNFLT = peripapillary retinal nerve fiber layer thickness; MD = mean deviation. Student's t-test

^† Mann-Whitney test.

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