Methotrexate and ophthalmology follow up

[Wraysbury]

Hi I had all the routine follow up tests done today in ophthalmology dept as I have low pressure glaucoma. The consultant looks at all our results and decides whether to see me and when. I told them I now have PMR and am taking prednisolone. My pressures are up, but still normal, I’ve lost some more vision in 6 months. So that concerned me. However the interesting thing is that Worcs Hosp now has a special clinic to follow up patients taking methotrexate They consider it a much greater risk than Pred. Perhaps u all knew that, but just in case u haven’t been checked, pls see what there is in your area

[DorsetLady PMRGCAuk volunteer]

Oh that’s interesting on 2 counts -

A. The hospital is checking on MTX, and

B. Their view of it!

Sorry to hear about reduced vision.

[PMRpro Ambassador]

Tell me more about that if you can. I haven't heard of mtx being a risk to sight. Is that for rheumatology doses or just for chemotherapy levels?

I found this: What a rheumatologist should know

ncbi.nlm.nih.gov/pmc/articl...

[patriciawhite in reply to PMRpro]

Rheumatologist did tell me to make sure I had regular eye tests when they put me on Methotrexate,they see me every 6 months and always ask about any recent eye tests .

[lfu2 in reply to PMRpro]

I found this on 'methotrexate and eyes'

"There is evidence that the drug can induce pigmentary changes of the macula and other areas of the retina causing symptoms of blurred vision. ... Blurred vision, photophobia and central vision changes may occur. Symptoms are generally rare." 9 Feb 2010.

[PMRpro Ambassador in reply to lfu2]

Hope this isn't one of those "rare" things that turns out be rather less than rare...

Thankyou

[Wraysbury]

I’ll ask more when I speak to the nurse and doctor on tues. the nurse practitioner just said methotrexate is the only steroid they’re really interested in as far as eyes are concerned. Tell me what to ask pls. She was helpful.

[PMRpro Ambassador in reply to Wraysbury]

Well apart from the fact mtx isn't a steroid...

Just ask if it is the low doses used in rheumatology they are concerned about. And what do they think of putting patients on both prednisolone AND methotrexate - does that increase the risks further?

[Linny3 in reply to Wraysbury]

I was on methotrexate for about 15 mos. No one ever said anything about the eyes. However, Prednisone can cause all sorts of problems with the eyes. My pressure has risen for the first time in my life. It is still normal, just keeping an eye on it. My eye dr. is more concerned about cataracts. Am Always between a rock and a hard place.! What a juggling act all these meds are becoming. I was just put on 3 new drugs for some of the side effects. I want from taking zero drugs to now taking 4. Not a happy camper.

[PMRpro Ambassador in reply to Linny3]

Nothing about eyes said to me either - but I ditched mtx after a mere 4 weeks. It definitely wasn't worth the grief.

OTOH - if only pred would cause cataracts. They hadn't after over 7 years so I doubt it will happen now - but I live in hope. I could chuck away my distance specs...

[SheffieldJane]

That is interesting. I can’t articulate why I keep dodging it ( Methotrexate) Some instinct for self preservation I guess.

I am glad your precious eyes are being closely monitored.

[Hidden]

No l didn’t know that! Thanks x

[Ronnie101]

Thanks for the info. You've just made up my mind to resist my rheumy's pressure to take methotroxate! I already have steroid induced cataracts (frustratingly not bad enough to have them done on the nhs!), and high eye pressures with narrow angles, so I'm inclined not to add to the list.

I hope you get your issues sorted.

[Wraysbury]

Thanks. I have low pressure thankfully although they had gone up yday. I had acute closed angle glaucoma at Christmas so had to have emergency laser. I tried to tell them that the level I am at now might be high for me, but they’re only interested if it goes over the average high!😩 another fight I fear cos I’ve already lost some central vision in both eyes, and more in the last 6 months. However as this is a PMR site id better stop. Good luck with yours

[PMRpro Ambassador in reply to Wraysbury]

Aren't they checking the central vision more closely? Think I'd be seeking an expert referral somehow...

[Wraysbury in reply to PMRpro]

The central vision has irredeemably gone unfortunately. Deteriorated very quickly after initial diagnosis. I’m speaking to them Monday and if I’m not satisfied with the answer I’m asking for a second opinion

[stellafmdm]

I've just asked my GP to refer me to get my cataracts done on the advice of the ophthalmologist, and my Rheumy wants to put me back on Methotrexate. I had to stop it due to Cholecystectomy. I am planning to refuse on the grounds that it will muck up my liver once again, but this will be a new string to my bow, eye problems!