Phosphodiesterase type 5 inhibitors, visual changes, and nonarteritic anterior ischemic optic neuropathy: Is there a link?

Abstract

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy and one of the most common causes of sudden vision loss in the elderly. Recently, NAION has been associated with the use of phosphodiesterase type 5 inhibitors (PDE5i) in men with erectile dysfunction (ED). A causal relationship could not be established given the large number of men safely using PDE5i and the limited number of NAION cases reported in these men. ED and NAION share common risk factors; therefore, some men with ED should be expected to develop NAION. However, sudden vision loss or decreased vision in one or both eyes demands immediate cessation of PDE5i use and urgent patient assessment. No causal relationship between PDE5i and the development of NAION exists for the moment, yet physicians should be aware of a possible adverse reaction and inform patients accordingly.

Sildenafil Attenuates Vaso-Obliteration and Neovascularization in a Mouse Model of Retinopathy of Prematurity

“…52,53 Whereas case reports have linked sildenafil treatment with potentially enhanced ROP progression and severity, 53 subsequent retrospective crosssectional studies have found no adverse outcomes in premature infants with ROP who were treated with sildenafil for pulmonary hypertension. 54,55 Previous studies of the effects of PDE5 inhibitors in the eye have focused largely on retinal and choroidal blood flow, showing increased choroidal congestion and ophthalmic artery velocity and flow, with controversial results in the retinal vasculature.…”

The effect of sildenafil on retinopathy of prematurity in very preterm infants

“…[7][8][9] In adults, the most common ophthalmological adverse effects of sildenafil use include mild and transient blurred vision, cyanopsia and altered perception of light. 10,11 Postmarketing surveillance of sildenafil has detected a number of case reports, reporting nonarteritic ischaemic optic neuropathy, associated with the use of sildenafil in adults. 11,12 However a causal relationship between sildenafil and nonarteritic ischaemic optic neuropathy has not been established in a number of systemic reviews.…”

“…10,11 Postmarketing surveillance of sildenafil has detected a number of case reports, reporting nonarteritic ischaemic optic neuropathy, associated with the use of sildenafil in adults. 11,12 However a causal relationship between sildenafil and nonarteritic ischaemic optic neuropathy has not been established in a number of systemic reviews. 11,13,14 In newborns, one case report raised the possible association of aggressive retinopathy of prematurity (ROP) and the use of sildenafil.…”

“…11,12 However a causal relationship between sildenafil and nonarteritic ischaemic optic neuropathy has not been established in a number of systemic reviews. 11,13,14 In newborns, one case report raised the possible association of aggressive retinopathy of prematurity (ROP) and the use of sildenafil. 15 A recent study investigated potentially adverse ocular effects of sildenafil treatment in term and preterm infants born after 34 weeks gestation.…”

Ophthalmic findings in neonates receiving sildenafil

“…A blinded review of 102 ophthalmic centres found 43 cases of definite NAION where phosphodiesterase type 5 inhibitors were used within 30 days prior to the event, giving an odds ratio of 2.15 . However, a recent systematic review found no evidence of a causal relationship between sildenafil and NAION …”