Effect of Psychotropic Medications on Ocular Parameters: A Naturalistic Study

INTRODUCTION: The incidence of psychiatric diseases and consequently prescription of psychotropic medications is increasing day by day. Ocular problems rising in relation to use of these drugs have important effect on psychiatric patients’ lifestyles.  AIM: The need to undertake this study project is to fill the lacunae in the understanding of the effects of psychotropic medications on intraocular pressure and vision and to obtain concrete evidence. MATERIAL AND METHODS: 200 patients with various DSM-5 psychiatric diagnosis were assessed in a naturalistic longitudinal cohort study and ophthalmological examinations were carried out in Ophthalmology Department of a tertiary care centre. Patients were screened according to inclusion and exclusion criteria and patients fulfilling said criteria were recruited. Data was pooled, tabulated and subjected to appropriate statistical tests.

RESULTS: Schizophrenia and related disorders were the most common diagnoses followed by substance use disorders, Major Depressive Disorder, Anxiety Disorders, Bipolar Mood Disorder, Obsessive Compulsive Disorder and others in that order. The range in duration of illness was 0.1 months in a patient of brief psychotic episode to 492 months in a case of alcohol use disorder. All 200 patients had their intraocular pressure within normal range. Majority of patients were started on and were receiving multiple psychotropic medications and in spite of receiving these medications, their intraocular pressure remained within normal range. After exposure to psychotropic medications, only 1 patient was found to have changes in the acuity of vision in the right eye and 2 patients had changes in the acuity of vision in the left eye, which may or may not have been effects of psychotropic medications.

CONCLUSIONS: Psychotropic medications in persons who do not have a predisposition to ocular pathology, do not bring about any change in near vision, distant vision or color vision. Similarly, in patients who are not predisposed to glaucoma, starting such patients on psychotropic medications will not bring about a pathological rise in intraocular pressure (IOP). Even if does cause a change in intraocular pressure, it remains within the normal range and doesn’t shift to pathological range.