From the Guidelines
Topiramate can cause vision changes that require immediate medical attention, including blurred vision, double vision, eye pain, and a sudden decrease in visual acuity, and patients should stop the medication and seek immediate medical care if they experience any of these symptoms. These vision changes can be serious and may include acute myopia (sudden nearsightedness) and secondary angle-closure glaucoma, which can lead to permanent vision loss if not treated promptly 1. The mechanism involves fluid shifts in the eye and swelling of the lens, which alters the eye's focusing ability and can increase pressure within the eye.
Some of the key vision changes associated with topiramate include:
- Blurred vision
- Double vision
- Eye pain
- Sudden decrease in visual acuity
- Acute myopia (sudden nearsightedness)
- Secondary angle-closure glaucoma
According to the most recent evidence, topiramate can cause these vision changes, and patients should be monitored closely for any signs of ocular toxicity 1. The evidence also suggests that topiramate can cause ciliary body edema and angle narrowing, which can increase the risk of angle-closure glaucoma 1.
If a patient experiences any vision changes while taking topiramate, they should stop the medication and seek immediate medical care. The doctor may need to perform a complete eye examination and will likely switch the patient to an alternative medication 1. It is essential to note that these vision changes are typically reversible if caught early, but delay in treatment can result in permanent vision damage. Therefore, it is crucial to prioritize the patient's vision health and seek medical attention immediately if any vision changes occur.
From the FDA Drug Label
TOPIRAMATE can impair your thinking, motor skills, and/or vision. eye problems. Serious eye problems include: a sudden decrease in vision (acute myopia) with or without eye pain and a blockage of fluid in the eye causing increased pressure in the eye (secondary angle closure glaucoma) Call your healthcare professional right away if you have a loss in vision or get eye pain.
Topiramate may cause vision changes, including a sudden decrease in vision (acute myopia) with or without eye pain, and a blockage of fluid in the eye causing increased pressure in the eye (secondary angle closure glaucoma). If you experience any eye problems or loss of vision, you should call your healthcare professional right away 2.
From the Research
Topiramate Vision Changes
- Topiramate has been associated with several ocular side effects, including choroidal effusion syndrome, angle-closure glaucoma, myopic shift, visual field defects, and myokymia 3, 4, 5.
- These complications can be severe and vision-threatening if not identified and treated promptly, potentially leading to permanent blindness 3, 4.
- The risk of adverse reactions with topiramate is 3%, and the prognosis is favorable if the drug is discontinued early and prompt therapy is initiated 4.
- Visual field defects secondary to topiramate are more commonly attributed to angle closure glaucoma due to ciliochoroidal effusion syndrome, but can also be caused by retinal damage and maculopathy 6, 5.
- A baseline perimetry is recommended for patients being considered for topiramate therapy to gauge any changes in their peripheral field of vision during treatment 6.
- Topiramate has also been associated with changes in refractive error, corneal thickness, and retinal nerve fiber layer thickness, with significant myopic shift and increase in retinal nerve fiber layer thickness observed in some studies 7.
Ocular Complications
- Choroidal effusion syndrome is a well-known ocular side effect of topiramate, which can cause angle-closure glaucoma and myopic shift 3, 4, 5.
- Visual field defects can occur due to various mechanisms, including retinal damage, maculopathy, and ciliochoroidal effusion syndrome 6, 5.
- Myokymia, uveitis, and neuro-ophthalmology complications are other rare ocular side effects associated with topiramate 3, 5.
- The exact mechanisms of these ocular complications are not fully understood and require further research 3, 5.
Clinical Implications
- Medical professionals and patients should be aware of the potential ocular side effects of topiramate, especially given its extensive use 3, 4.
- Prompt recognition and intervention can prevent potential visual loss in patients taking topiramate 4.
- Regular ophthalmological examinations are recommended for patients taking topiramate to monitor for any changes in their vision or ocular health 3, 5.