Canadian Opthalmologists are calling on health bodies to investigate routine eye screening for women using tamoxifen.
In a research article published this week in JAMA Ophthalmology, experts based at Queens University, Sunnybrook Health Sciences Centre, University of British Columbia and University of Alberta report that ophthalmologists rarely meet women who are taking tamoxifen – despite their elevated risk of retinopathy.
Low Uptake of Retinal Exams For Women Using Tamoxifen
The researchers probed the American government’s National Institutes of Health All of Us Research Program database to figure out whether opticians and ophthalmologists were regularly seeing women who were using tamoxifen. Concerningly, only 7% of women prescribed tamoxifen had had an eye exam in the year following starting their treatment. Of 2327 women recorded in the dataset, only 162 had met an optician or ophthalmologist, despite their higher risk of developing retinopathy. Just 1.7% of women using tamoxifen had had a retinal examination in the 12 months since their first tamoxifen dose.
In contrast, people using the lupus drug hyrdoxychloroquine, which has a lower rate of retinopathy in the first few years of use, are offered annual screening for retinopathy. At least half of eligible patients attend screening.
Currently there are no guidelines for retina screening in place for women using tamoxifen. The researchers argue that it’s time for more research into incidence of tamoxifen induced retinopathy and potential screening methods.
A Serious Drug For a Serious Condition
Tamoxifen is a drug that inhibits oestrogen receptors. Cancer doctors use it as a helper drug to boost treatments for some types of breast cancer. This is a powerful drug with a lot of side effects. One such side effect is that it can cause retinal toxicity. Some reports say that as many as12% of women who take a standard daily 20 mg dose for two years go on to develop eye problems. Examples include crystalline maculopathy, pseudocystic foveal cavitation and cystoid macular oedema. All of these conditions can lead to irreversible vision loss.
Because very little research has focused on the link between retinopathy and tamoxifen, doctors aren’t sure how common this side effect really is. The low attendance of potentially affected women at eye appointments that eye doctors found in this study is a cause for concern. The specialists, headed up by Siddharth Gandhi of Queens University, Ontario, point out that we don’t know how prevalent this issue is, how soon the early signs show up or how many women have no idea that they should even be having their retina looked at.
While we wait for the research to catch up, even if you don’t think you are at high risk for retinopathy, it’s always wise to stay up to date with vision care – including retinal exams.
Sources
Gandhi S, Balas M, Wang P, McKay BR, Kertes PJ, Martens R. Ophthalmic Encounters After Tamoxifen Initiation. JAMA Ophthalmol. Published online October 29, 2026. doi:10.1001/jamaophthalmol.2026.4646
Hydroxychloroquine-Induced Retinal Toxicity – Patients – The American Society of Retina Specialists. Accessed October 29, 2026. https://www.asrs.org/patients/retinal-diseases/45/hydroxychloroquine-induced-retinal-toxicity
Tenney S, Oboh-Weilke A, Wagner D, Chen MY. Tamoxifen retinopathy: A comprehensive review. Survey of Ophthalmology. 2024;69(1):42-50. doi:10.1016/j.survophthal.2023.07.003
