From the Guidelines
Topiramate can cause vision changes, including blurred vision, eye pain, and halos around lights, and patients should seek immediate medical attention if they experience any of these symptoms. These vision problems can be a sign of acute myopia, secondary angle closure glaucoma, or visual field defects, which can progress rapidly and potentially lead to permanent vision loss if not addressed promptly 1. The mechanism behind these vision changes involves fluid accumulation in the eye and swelling of the lens, which alters the eye's focusing ability and can increase intraocular pressure. Some of the key points to consider when prescribing topiramate include:
- Risk factors for vision changes, such as being female, having a smaller eye structure, and taking higher doses 1
- The importance of regular eye exams for patients on long-term topiramate therapy to monitor for any developing vision issues, especially during the initial treatment period
- The need for patients to seek immediate medical attention if they experience any vision changes while taking topiramate
- The potential for topiramate to cause other adverse effects, such as cognitive impairment, constipation, dry mouth, palpitations, paresthesias, dysgeusia, and irritability 1 It is essential to weigh the benefits and risks of topiramate therapy and to consider alternative medications if vision problems occur. In terms of management, the following steps can be taken:
- Discontinuing topiramate and prescribing alternative medications if vision problems occur
- Regular eye exams for patients on long-term topiramate therapy
- Monitoring for any developing vision issues, especially during the initial treatment period
- Counseling patients on the risks of vision changes and the importance of seeking immediate medical attention if they experience any symptoms.
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) A syndrome consisting of acute myopia associated with secondary angle closure glaucoma has been reported in patients receiving Topiramate. Symptoms include acute onset of decreased visual acuity and/or ocular pain
Vision changes associated with topiramate use include:
- Acute myopia
- Secondary angle closure glaucoma
- Decreased visual acuity
- Ocular pain It is recommended to monitor patients for signs of eye problems and to seek medical attention immediately if any symptoms occur 2 2.
From the Research
Topiramate Vision Changes
- Topiramate, a sulfonamide drug, has been associated with several ocular side effects, including choroidal effusion syndrome, angle-closure glaucoma, and myopic shift 3, 4, 5.
- Other potential vision changes include retinal problems, uveitis, visual field defects, myokymia, and neuro-ophthalmology complications 3, 6, 5.
- These vision changes can be severe and vision-threatening if not identified and treated promptly, potentially leading to permanent blindness 3, 4, 7.
- 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.
- It is recommended to obtain a baseline perimetry in patients being considered for topiramate therapy to gauge any changes in their peripheral field of vision during treatment 6.
- Topiramate-induced vision changes can occur suddenly, and delayed or incorrect treatment may result in permanent vision loss 7.
- Prescribing physicians should be aware of the potential ocular side effects of topiramate and take them seriously, subjecting patients to ophthalmic counseling if necessary 3, 5.