Tamoxifen side effects, age-related macular degeneration (AMD) or cancer associated retinopathy (CAR)?

PURPOSE. Differential diagnosis of maculopathies can be difficult but is im portant if patients also suffer from other diseases such as breast cancer t reated with antiestrogens. The main possible diagnoses, especially in the e lderly, are age-related macular degeneration, tamoxifen and cancer-associat ed retinopathy (CAR). METHODS. We describe an 84-year-old patient with breast and colon cancer, w ho complained of a decrease in visual acuity after treatment with low-dose antiestrogens. She underwent a general ophthalmological investigation, peri metry and electroretinographic examination with multifocal (m-ERG) and flas h-electroretinogram (flash-ERG). RESULTS. Visual acuity was reduced to 1/50 and 0.3. The ophthalmological ex amination was normal, except for extensive bilateral maculopathy with shini ng crystalline deposits, central and peripheral visual field defects, sligh tly affected scotopic and photopic potentials in the flash-ERG, and an abno rmal m-ERG. CONCLUSIONS. The findings are expected with age-related macular degeneratio n with crystalline drusen, but also with CAR. Even if the single and total dosage of antiestrogens given to the patient is sufficient to cause tamoxif en retinopathy, this diagnosis can be excluded because, in tamoxifen retino pathy unlike in the case presented here, the deposits are not distributed i n all retinal layers.