Subjective visual halos after sildenafil (Viagra) administration

Gabrieli, C. Balacco; Regine, Federico; Vingolo, Enzo Maria; Rispoli, Eduardo; Fabbri, Andrea; Isidori, Andrea M.

doi:10.1016/s0161-6420(00)00648-5

Cited by 38 publications

(15 citation statements)

References 10 publications

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“…However, unlike the previous study these changes did not resolve by 5 h 61 . In an interventional case report describing the ERG changes in a patient reporting bluish hue and increased sensitivity to light after every sildenafil dose, there were statistically significant variations from baseline in parameters of the best‐fit Naka–Rushton function 43 . Following sildenafil ingestion Vmax was significantly higher (indicating higher rod response to light stimuli) and K was lower (higher rod sensitivity) than baseline in this patient 43 .…”

Section: Retinal Toxicitycontrasting

confidence: 71%

“…Phosphodiesterase type 6 inhibition may be expected to result in an increased sensitivity to lights by causing weak depolarization of the rod outer segment and this is supported by electroretinogram (ERG) studies showing an increase in Vmax (higher rod response to light stimuli) and decrease in K (higher sensitivity) following sildenafil ingestion 43 …”

Section: Visual Side‐effectsmentioning

confidence: 92%

“…In an interventional case report describing the ERG changes in a patient reporting bluish hue and increased sensitivity to light after every sildenafil dose, there were statistically significant variations from baseline in parameters of the best‐fit Naka–Rushton function 43 . Following sildenafil ingestion Vmax was significantly higher (indicating higher rod response to light stimuli) and K was lower (higher rod sensitivity) than baseline in this patient 43 . These findings would be consistent with the patient's subjective symptoms of increased sensitivity to light and may be explained by partial depolarization of the rod outer segment as a result of PDE6 inhibition 43 …”

Section: Retinal Toxicitymentioning

confidence: 99%

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Phosphodiesterase inhibitors and the eye

Kerr

Danesh‐Meyer

2009

Clinical Exper Ophthalmology

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Phosphodiesterase type 5 (PDE5) inhibitors are effective oral treatments for erectile dysfunction and have become one of the most widely prescribed medications worldwide. The mechanism of action is to reduce the degradation of cyclic GMP (cGMP) potentiating the effect of nitric oxide in the corpus cavernosum and allowing erectile function to occur by consequent relaxation of penile smooth muscle. Because of the presence of PDE5 in choroidal and retinal vessels these medications increase choroidal blood flow and cause vasodilation of the retinal vasculature. The most common symptoms are a blue tinge to vision and an increased sensitivity to light. There have been reports of non-arteritic anterior ischaemic optic neuropathy and serous macular detachment in users of PDE5 inhibitors, although a causal relationship has not been conclusively shown. Despite the role of cGMP in the production and drainage of aqueous humour these medications do not appear to alter intraocular pressure and are safe in patients with glaucoma. All PDE5 inhibitors weakly inhibit PDE6 located in rod and cone photoreceptors resulting in mild and transient visual symptoms that correlate with plasma concentrations. Psychophysical tests reveal no effect on visual acuity, visual fields or contrast sensitivity; however, some studies show a mild and reversible impairment of blue-green colour discrimination. PDE5 inhibitors transiently alter retinal function on electroretinogram testing but do not appear to be retinotoxic. Despite the role of cyclic nucleotides in tear production there is no detrimental effect on tear film quality. Based on the available evidence PDE5 inhibitors have a good ocular safety profile.

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Section: Retinal Toxicitycontrasting

confidence: 71%

Section: Visual Side‐effectsmentioning

confidence: 92%

Section: Retinal Toxicitymentioning

confidence: 99%

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Phosphodiesterase inhibitors and the eye

Kerr

Danesh‐Meyer

2009

Clinical Exper Ophthalmology

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“…4 Prerelease studies have examined the effects of sildenafil on visual measures. [10][11][12] Gabrieli et al 10 have found that sildenafil administration resulted in a higher rod response to light stimuli and in a higher rod sensitivity due to weak PDE6 inhibition induced by sildenafil. Vobig et al 11 have found a significant reduction in the amplitude of maximal scotopic a-wave and b-wave in five volunteers, 1 h after taking 100 mg sildenafil.…”

Section: Discussionmentioning

confidence: 99%

Effects of sildenafil on ocular perfusion demonstrated by color Doppler ultrasonography

et al. 2004

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The aim of this study was to investigate the effects of sildenafil on ocular hemodynamics by color Doppler ultrasonography (CDU). In all, 38 patients with erectile dysfunction diagnosed by International Index of Erectile Function (IIEF) and Sexual Health Inventory of Men (SHIM) scores were included into the study. After taking 100 mg of oral sildenafil citrate, all patients underwent CDU examination of central retinal artery at 60 and 75 min and CDU examination of cavernosal artery at 20, 60 and 75 min. All of the side effects during and after the test were also recorded. The mean cavernous artery peak systolic flow velocity increased significantly after sildenafil. However, no significant change was determined in central retinal artery flow parameters including peak systolic flow velocity, end-diastolic flow velocity, resistive index, pulsatility index, volume and diameter. Five patients experienced ocular side effects. No significant change was observed in retinal artery CDU measurements of patients having ocular side effects. Sildenafil has no effect on ocular hemodynamics on the basis of CDU. Ocular side effects may be the result of other changes in retinal photoreceptors rather than the ocular circulation.

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“…However, variable systemic and ocular side effects have been reported. The ocular side effects include visual halo (2), third nerve palsy (3), nonarteritic anterior ischemic optic neuritis (4, 5), etc. As observed with sildenafil, DA-8159 may cause such ocular side effects.…”

Section: Introductionmentioning

confidence: 99%

Effect of DA-8159, a Selective Phosphodiesterase Type 5 Inhibitor, on Electroretinogram and Retinal Histology in Rabbits

et al. 2004

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DA-8159, a selective inhibitor of phosphodiesterase type 5, was developed as a new drug for erectile dysfunction. The effect of DA-8159 on the electroretinogram (ERG) and the retinal histopathology were evaluated in rabbits. The ERG was performed prior to, and 1 and 5 hr after DA-8159 (5 to 30 mg/kg) administration. The plasma concentration of DA-8159 was determined at each time point, and retinal microscopic examination was also performed. There was no statistically significant ERG change at any dose or at any time. Though the 30 Hz flicker showed a prolongation of the implicit time at 5 hr after the administration of either DA-8159 15 mg or 30 mg/kg (p<0.05), but concurrent amplitude decreases were not statistically significant. At a dose of 5 mg/kg, no test drug was detected in the blood after either 1 or 5 hr. At either 15 mg/kg or 30 mg/kg, there was a dose-dependent increase in the blood concentration after 1 hr of drug administration, which decreased with time. In light and electron microscopic examinations of the retina, there was no remarkable change at any dose. These results suggest DA-8159 has a low risk potential to the retina, but further evaluation on the visual functions in human is needed.

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Subjective visual halos after sildenafil (Viagra) administration

Cited by 38 publications

References 10 publications

Phosphodiesterase inhibitors and the eye

Phosphodiesterase inhibitors and the eye

Effects of sildenafil on ocular perfusion demonstrated by color Doppler ultrasonography

Effect of DA-8159, a Selective Phosphodiesterase Type 5 Inhibitor, on Electroretinogram and Retinal Histology in Rabbits

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