P-102: Ocular complications are common in patients with multiple myeloma receiving dexamethasone: Results of a cross-sectional patient survey

Introduction: Treatments for multiple myeloma (MM) may predispose patients to ocular comorbidities such as cataracts and glaucoma from dexamethasone (dex), blepharitis from bortezomib, or keratopathy from belantamab mafodotin. Little is known about eye health in MM with regard to the prevalence of ocular comorbidities and eye health-related behaviors, e.g. periodic ocular exams as recommended for older adults by the American Academy of Ophthalmology.

Methods: We conducted an IRB-approved survey of patients with MM through HealthTree Cure Hub for Multiple Myeloma. Patients answered questions about their demographics, MM history, ocular comorbidities, frequency of eye health visits, and interference with instrumental activities of daily living (IADLs; i.e., driving) due to ocular disorders. For cataracts and glaucoma, patients reported their most common typical weekly dex dose in milligrams (mg), which was grouped into high-dose (20-40 mg), low-dose (1-19 mg), no-therapy (no dex), and unsure. Responses were analyzed descriptively.

Results: Of n=582 respondents, the mean age was 65.9 with 36% (n=211) aged 70+ at survey completion. Dex exposures were high-dose in 50% (n=290), low-dose in 12% (n=71), and no-therapy in 30% (n=177). The prevalence of cataracts was 63% for high-dose dex, 53% low-dose dex, and 51% no-therapy (p=0.025). Cataracts were asymptomatic in 43% (n=144), whereas 7% (n=23) of patients with cataracts reported resultant IADL limitations. The prevalence of glaucoma (7-11%, p=0.60) was comparable between the three dex groups, with 8% (n=4) of patients with glaucoma reporting IADL changes. Blepharitis or styes were reported by 23% (n=134), with 6% (n=8) of patients with blepharitis reporting resultant IADL limitations. Blepharitis was more common in bortezomib-exposed than bortezomib-unexposed patients (27% vs 20%, p=0.039). Other reported issues included dry eyes (39%, n=226), any type of orbital inflammation (2%, n=11), and retinal vascular occlusion (1%, n=6). With regard to eye health, 82% (n=476) reported seeing an optometrist or ophthalmologist at least once per year. Only 32% (n=170) recalled that an oncologist had recommended periodic eye exams.

Conclusions: hile limited by recall bias and lack of longitudinal treatment exposure data, our cross-sectional study of over 500 patients living with MM illustrates the wide spectrum of ocular comorbidities and toxicities. Consistent with previous findings (Banerjee AJH 2024), higher dex doses are associated with greater rates of cataracts; however, dex dosing did not impact patient-reported rates of glaucoma. Blepharitis, often thought to be a rare toxicity of bortezomib, was reported by almost a quarter of patients even if bortezomib-unexposed. Interference with IADLs was fortunately infrequent. Our findings suggest that periodic eye exams, although inconsistently recommended by oncologists, are generally considered by patients living with MM to be a key component of supportive care.